title: Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study.
abstract: Stroke-associated infections occur frequently and are associated with unfavorable outcome. Previous cohort studies suggest a protective effect of beta-blockers (BBs) against infections. A sympathetic drive may increase immune suppression and infections.
  
  
  
  This study is aimed at investigating the association between BB treatment at baseline and post-stroke infection in the Preventive Antibiotics in Stroke Study (PASS), a prospective clinical trial.
  
  
  
  We performed an exploratory analysis in PASS, 2,538 patients with acute phase of stroke (24 h after onset) were randomized to ceftriaxone (intravenous, 2 g per day for 4 days) in addition to stroke unit care, or standard stroke unit care without preventive antibiotic treatment. All clinical data, including use of BBs, was prospectively collected. Infection was diagnosed by the treating physician, and independently by an expert panel blinded for all other data. Multivariable analysis was performed to investigate the relation between BB treatment and infection rate.
  
  
  
  Infection, as defined by the physician, occurred in 348 of 2,538 patients (14%). Multivariable analysis showed that the use of BBs at baseline was associated with the development of infection during clinical course (adjusted OR (aOR) 1.61, 95% CI 1.19-2.18; p < 0.01). BB use at baseline was also associated with the development of pneumonia (aOR 1.56, 95% CI 1.05-2.30; p = 0.03). Baseline BB use was not associated with mortality (aOR 1.14, 95% CI 0.84-1.53; p = 0.41) or unfavorable outcome at 3 months (aOR 1.10, 95% CI 0.89-1.35; p = 0.39).
  
  
  
  Patients treated with BBs prior to stroke have a higher rate of infection and pneumonia.
authors.affiliation: Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Willeke F
authors.initials: WF
authors.lastname: Westendorp
authors.forename: Jan-Dirk
authors.initials: JD
authors.lastname: Vermeij
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.forename: Y B W E M
authors.initials: YB
authors.lastname: Roos
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D001424:Bacterial Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009894:Opportunistic Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control*; D018410:Pneumonia, Bacterial / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D013997:Time Factors; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000319:Adrenergic beta-Antagonists; D000900:Anti-Bacterial Agents; D002443:Ceftriaxone