Westendorp Willeke F, Vermeij Jan-Dirk, Vermeij Frederique, Den Hertog Heleen M, Dippel Diederik W J, van de Beek Diederik, Nederkoorn Paul J
Department ofNeurology,Academic Medical Center, Amsterdam, Netherlands.
Cochrane Database Syst Rev. 2012 Jan 18;1:CD008530. doi: 10.1002/14651858.CD008530.pub2.
Stroke is the main cause of disability in high income countries and ranks second as a cause of death worldwide. Infections occur frequently after stroke and may adversely affect outcome. Preventive antibiotic therapy in the acute phase of stroke may reduce infections and improve outcome.
We searched the Cochrane Stroke Group's Trials Register (October 2010); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); MEDLINE (1950 to October 2010) and EMBASE (1980 to October 2010). In an effort to identify further published, unpublished and ongoing trials we searched trials and research registers, scanned reference lists and contacted authors, colleagues and researchers in the field.
Randomised controlled trials (RCTs) of preventive antibiotic therapy versus control (placebo or open control) in patients with acute ischaemic or haemorrhagic stroke.
Two authors independently selected articles and performed data extraction; we discussed and resolved discrepancies in a consensus meeting with a third observer. We contacted the study authors to obtain missing data when required. An independent observer assessed methodological quality. We calculated relative risks (RRs) for dichotomous outcomes, assessed heterogeneity amongst included studies and performed subgroup analyses on study quality.
We included five studies involving 506 patients. Study population, study design, type of antibiotic and definition of infection differed considerably. The number of patients who died in the preventive antibiotic group was non-significantly reduced (33/248 (13%) versus 38/258 (15%), RR 0.85, 95% confidence interval (CI) 0.47 to 1.51); the number of dependent patients in the preventive antibiotic therapy group was also non-significantly reduced (97/208 (47%) versus 127/208 (61%), RR 0.67, 95% CI 0.32 to 1.43). Preventive antibiotic therapy did reduce the incidence of infections in patients with acute stroke from 36% to 22% (36/166 (22%) versus 61/169 (36%), RR 0.58, 95% CI 0.43 to 0.79). No major side-effects of preventive antibiotic therapy were reported.
AUTHORS' CONCLUSIONS: In this meta-analysis, preventive antibiotic therapy seemed to reduce the risk of infection, but did not reduce the number of dependent or deceased patients. However, the included studies were small and heterogeneous. Large randomised trials are urgently needed.
在高收入国家，中风是导致残疾的主要原因，在全球范围内是第二大致死原因。中风后感染频繁发生，可能对预后产生不利影响。中风急性期的预防性抗生素治疗可能会减少感染并改善预后。
我们检索了Cochrane中风小组试验注册库（2010年10月）；Cochrane对照试验中央注册库（CENTRAL）（《Cochrane图书馆》2010年第3期）；MEDLINE（1950年至2010年10月）和EMBASE（1980年至2010年10月）。为了识别更多已发表、未发表和正在进行的试验，我们检索了试验和研究注册库，查阅了参考文献列表，并联系了该领域的作者、同事和研究人员。
急性缺血性或出血性中风患者预防性抗生素治疗与对照（安慰剂或开放对照）的随机对照试验（RCT）。
两位作者独立选择文章并进行数据提取；我们在与第三位观察者的共识会议上讨论并解决了差异。必要时，我们联系研究作者以获取缺失数据。一位独立观察者评估方法学质量。我们计算二分结果的相对风险（RRs），评估纳入研究之间的异质性，并对研究质量进行亚组分析。
我们纳入了五项涉及506名患者的研究。研究人群、研究设计、抗生素类型和感染定义差异很大。预防性抗生素组的死亡患者数量减少但无统计学意义（33/248（13%）对38/258（15%），RR 0.85，95%置信区间（CI）0.47至1.51）；预防性抗生素治疗组的依赖患者数量也减少但无统计学意义（97/208（47%）对127/208（61%），RR 0.67，95%CI 0.32至1.43）。预防性抗生素治疗确实将急性中风患者的感染发生率从36%降至22%（36/166（22%）对61/169（36%），RR 0.58，95%CI 0.43至0.
