Antibiotic prophylaxis for infections in patients with acute stroke: a systematic review and meta-analysis of randomized controlled trials
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Yan-Guo Xi1,*, Xu Tian2,*, Wei-Qing Chen2,*, Sai Zhang3,*, Shan Zhang1, Wei-Dan Ren1, Qi-Jun Pang1, Guo-Tao Yang1 and Zhi-Ming Yang1
1Department of Neurosurgery, Cang Zhou Central Hospital, Hebei 061001, China
2Department of Gastroenterology, Chongqing Cancer Institute and Hospital and Cancer Center, Chongqing 400030, China
3Department of Neurosurgery, Logistic University Affiliated Hospital, Logistic University of Chinese People’s Armed Police Force, Tianjin 300162, China
*These authors contributed equally to this work
Yan-Guo Xi, email: [email protected]
Xu Tian, email: [email protected]
Keywords: acute stroke, antibiotic prophylaxis, systematic review, meta-analysis
Received: March 22, 2017 Accepted: June 17, 2017 Published: July 06, 2017
Objective: Infections are frequent after stroke and lead to increased mortality and neurological disability. Antibiotic prophylaxis has potential of decreasing the risk of infections and mortality and improving poor functional outcome. Several studies evaluated antibiotic prophylaxis for infections in acute stroke patients have generated conflicting results. The systematic review of randomized clinical trials (RCTs) aimed at comprehensively assessing the evidence of antibiotic prophylaxis for the treatment of acute stroke patients.
Materials and Methods: PubMed, EMBASE, the Cochrane library and the reference lists of eligible articles were searched to identify all potential studies. We included the studies that investigated the efficacy and safety of antibiotic prophylaxis for the treatment of acute stroke patients. The primary outcome included mortality and infection rate. The secondary outcomes included poor functional outcome and adverse events.
Results: Seven trials randomizing 4,261 patients were included. Pooled analyses showed that antibiotic prophylaxis did not improve the mortality (risk ratio (RR) = 1.03, 95% confidence interval (CI) 0.84 to 1.26, p = 0.78, I2 = 25%) and poor functional outcome (RR = 0.93, 95% CI 0.80 to 1.08, p = 0.32, I2 = 80%), but reduced the incidence of infection (RR = 0.67, 95% CI 0.53 to 0.84, p = 0.0007, I2 = 49%). No major side effects were reported. Sensitivity analyses confirmed the results of infection rate and poor functional outcome.
Conclusions: Antibiotic prophylaxis can be used to treat the infectious events of acute stroke patients although it has no potential of decreased mortality and improved functional outcome.
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