Westendorp Willeke F, Vermeij Jan-Dirk, Brouwer Matthijs C, Roos Y B W E M, Nederkoorn Paul J, van de Beek Diederik
Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Cerebrovasc Dis. 2016;42(5-6):506-511. doi: 10.1159/000450926. Epub 2016 Oct 5.
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.
卒中相关性感染频繁发生且与不良预后相关。既往队列研究提示β受体阻滞剂（BBs）对感染有保护作用。交感神经驱动可能会增加免疫抑制及感染风险。
本研究旨在调查在一项前瞻性临床试验即卒中预防性抗生素研究（PASS）中，基线时使用BB治疗与卒中后感染之间的关联。
我们在PASS中进行了一项探索性分析，2538例处于卒中急性期（发病后24小时）的患者被随机分为两组，一组除接受卒中单元护理外，还接受头孢曲松治疗（静脉注射，每日2g，共4天），另一组接受不进行预防性抗生素治疗的标准卒中单元护理。所有临床数据，包括BBs的使用情况，均进行前瞻性收集。感染由治疗医师诊断，并由对所有其他数据不知情的专家小组独立诊断。进行多变量分析以研究BB治疗与感染率之间的关系。
医师定义的感染发生在2538例患者中的348例（14%）。多变量分析显示，基线时使用BBs与临床病程中感染的发生相关（校正比值比（aOR）为1.61，95%置信区间为1.19 - 2.18；p < 0.01）。基线时使用BBs也与肺炎的发生相关（aOR为1.56，95%置信区间为1.05 - 2.30；p = 0.03）。基线时使用BBs与死亡率（aOR为1.14，95%置信区间为0.84 - 1.53；p = 0.41）或3个月时的不良预后（aOR为1.10，95%置信区间为0.89 - 1.35；p = 0.39）无关。
卒中前接受BBs治疗的患者感染和肺炎发生率更高。
