RT Journal Article
T1 Antibiotic Class and Outcome in Post-stroke Infections: An Individual Participant Data Pooled Analysis of VISTA-Acute.
A1 Smith, Craig J
A1 Heal, Calvin
A1 Vail, Andy
A1 Jeans, Adam R
A1 Westendorp, Willeke F
A1 Nederkoorn, Paul J
A1 van-de-Beek, Diederik
A1 Kalra, Lalit
A1 Montaner, Joan
A1 Woodhead, Mark
A1 Meisel, Andreas
K1 acute
K1 antibiotics
K1 post-stroke infections
K1 post-stroke pneumonia
K1 prognosis
K1 stroke
AB Introduction: Antibiotics used to treat post-stroke infections have differing antimicrobial and anti-inflammatory effects. Our aim was to investigate whether antibiotic class was associated with outcome after post-stroke infection. Methods: We analyzed pooled individual participant data from the Virtual International Stroke Trials Archive (VISTA)-Acute. Patients with ischemic stroke and with an infection treated with systemic antibiotic therapy during the first 2 weeks after stroke onset were eligible. Antibiotics were grouped into eight classes, according to antimicrobial mechanism and prevalence. The primary analysis investigated whether antibiotic class for any infection, or for pneumonia, was independently associated with a shift in 90 day modified Rankin Scale (mRS) using ordinal logistic regression. Results: 2,708 patients were eligible (median age [IQR] = 74 [65 to 80] y; 51% female; median [IQR] NIHSS score = 15 [11 to 19]). Pneumonia occurred in 35%. Treatment with macrolides (5% of any infections; 9% of pneumonias) was independently associated with more favorable mRS distribution for any infection [OR (95% CI) = 0.59 (0.42 to 0.83), p = 0.004] and for pneumonia [OR (95% CI) = 0.46 (0.29 to 0.73), p = 0.001]. Unfavorable mRS distribution was independently associated with treatment of any infection either with carbapenems, cephalosporins or monobactams [OR (95% CI) = 1.62 (1.33 to 1.97), p< 0.001], penicillin plus β-lactamase inhibitors [OR (95% CI) = 1.26 (1.03 to 1.54), p = 0.025] or with aminoglycosides [OR (95% CI) = 1.73 (1.22 to 2.46), p = 0.002].Conclusion: This retrospective study has several limitations including effect modification and confounding by indication. Macrolides may have favorable immune-modulatory effects in stroke-associated infections. Prospective evaluation of the impact of antibiotic class on treatment of post-stroke infections is warranted.
PB Frontiers Research Foundation
SN 1664-2295
YR 2019
FD 2019-05-14
LK http://hdl.handle.net/10668/14061
UL http://hdl.handle.net/10668/14061
LA en
NO Smith CJ, Heal C, Vail A, Jeans AR, Westendorp WF, Nederkoorn PJ, et al. Antibiotic Class and Outcome in Post-stroke Infections: An Individual Participant Data Pooled Analysis of VISTA-Acute. Front Neurol. 2019 May 14;10:504.
DS RISalud
RD Apr 12, 2025