Zheng Feng, Spreckelsen Niklas von, Zhang Xintong, Stavrinou Pantelis, Timmer Marco, Dohmen Christian, Goldbrunner Roland, Cao Fang, Zhang Qiang, Ran Qishan, Li Gang, Fan Ruiming, Yao Shengtao, Krischek Boris
Department of Neurosurgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
Department of Neurosurgery, University Hospital of Cologne, Cologne, Germany.
PLoS One. 2017 Oct 19;12(10):e0186607. doi: 10.1371/journal.pone.0186607. eCollection 2017.
Infection is a common complication in acute stroke. Whether or not preventive antibiotics reduce the risk of infection or even lead to a favorable outcome and reduction of mortality after a stroke still remains equivocal. This review was performed to update the current knowledge on the effect and possible benefits of prophylactic antibiotic therapy in patients with stroke.
A systematic review and meta-analysis of preventive antibiotics`effect on the incidence of infection, favorable outcome (mRS≤2) and mortality in patients with acute stroke is performed with relevant randomized controlled trials.
Six studies were identified, involving 4125 participants. Compared with the control group, the treated groups were significantly less prone to suffer from early overall infections [RR = 0.52, 95%CI (0.39, 0.70), p<0.0001], early pneumonia [RR = 0.64, 95%CI (0.42, 0.96), p = 0.03] and early urinary tract infections [RR = 0.35, 95%CI (0.25, 0.48), p<0.00001]. However, there was no significant difference in overall mortality [RR = 1.07, 95%CI (0.90, 1.27), p = 0.44], early mortality [RR = 0.99, 95%CI (0.78, 1.26), p = 0.92], late mortality [RR = 1.12, 95%CI (0.94, 1.35), p = 0.21] or favorable outcome [RR = 1.00, 95%CI (0.92, 1.08), p = 0.98].
Although preventive antibiotic treatment did reduce the occurrence of early overall infections, early pneumonia and early urinary tract infection in patients with acute stroke, this advantage was not eventually translated to a favorable outcome and reduction in mortality. Future studies are warranted to identify any subgroup of stroke patients who might benefit from preventive antibiotic treatment.
感染是急性中风的常见并发症。预防性使用抗生素是否能降低感染风险，甚至改善中风后的预后并降低死亡率，目前仍不明确。本综述旨在更新有关预防性抗生素治疗对中风患者的影响及潜在益处的现有知识。
通过相关随机对照试验，对预防性抗生素对急性中风患者感染发生率、良好预后（改良Rankin量表评分≤2）和死亡率的影响进行系统评价和荟萃分析。
共纳入6项研究，涉及4125名参与者。与对照组相比，治疗组早期总体感染[相对危险度（RR）=0.52，95%可信区间（CI）（0.39，0.70），p<0.0001]、早期肺炎[RR = 0.64，95%CI（0.42，0.96），p = 0.03]和早期尿路感染[RR = 0.35，95%CI（0.25，0.48），p<0.00001]的发生率显著更低。然而，总体死亡率[RR = 1.07，95%CI（0.90，1.27），p = 0.44]、早期死亡率[RR = 0.99，95%CI（0.78，1.26），p = 0.92]、晚期死亡率[RR = 1.12，95%CI（0.94，1.35），p = 0.21]或良好预后[RR = 1.00，95%CI（0.92，1.08），p = 0.98]方面无显著差异。
尽管预防性抗生素治疗确实降低了急性中风患者早期总体感染、早期肺炎和早期尿路感染的发生率，但这一优势最终并未转化为良好预后和死亡率的降低。未来有必要开展研究，以确定可能从预防性抗生素治疗中获益的中风患者亚组。
