Schwarz Stefan
Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
Neurotherapeutics. 2016 Oct;13(4):783-790. doi: 10.1007/s13311-016-0466-y.
Infections, in particular pneumonia, are common complications in patients with acute stroke and are associated with a less favorable neurologic and functional outcome. Patients with severe stroke and dysphagia are at highest risk of infection. Experimental and clinical data suggest stroke-induced immunodeficiency as a major factor contributing to the high incidence of infection after stroke. Preclinical studies support the potential benefit of preventive antibiotic therapy in acute stroke for lowering the incidence of infection and improving clinical outcome. Several smaller clinical trials on preventive antibiotic therapy in patients with stroke conducted during the last 10 years yielded inconclusive results. Recently, 2 large, open-label, controlled trials failed to demonstrate an improved clinical outcome after preventive antibiotic therapy in patients with acute stroke treated in specialized stroke units. In the "Preventive Antibiotics in Stroke Study", antibiotic therapy lowered the rate of infection but did not influence outcome. In the STROKE-INF study, performed in patients with dysphagia after stroke, antibiotic therapy did not lower the incidence of pneumonia and had no prognostic significance. At present, preventive antibiotic therapy cannot be recommended as a therapeutic option for acute stroke.
感染，尤其是肺炎，是急性中风患者常见的并发症，并且与较差的神经和功能预后相关。重症中风和吞咽困难患者发生感染的风险最高。实验和临床数据表明，中风诱发的免疫缺陷是导致中风后感染高发的主要因素。临床前研究支持预防性抗生素治疗对急性中风患者降低感染发生率和改善临床预后具有潜在益处。过去10年中开展的几项关于中风患者预防性抗生素治疗的小型临床试验结果尚无定论。最近，两项大型、开放标签的对照试验未能证明在专门的中风单元接受治疗的急性中风患者进行预防性抗生素治疗后临床预后有所改善。在“中风预防性抗生素研究”中，抗生素治疗降低了感染率，但未影响预后。在中风后吞咽困难患者中进行的STROKE-INF研究中，抗生素治疗并未降低肺炎的发生率，也没有预后意义。目前，预防性抗生素治疗不能作为急性中风的一种治疗选择被推荐。
