Antibiotic Class and Outcome in Post-stroke Infections: An individual participant data pooled analysis of VISTA-acute

VISTA Collaboration and PISCES Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Article number504
JournalFrontiers in Neurology
Volume10
Issue numberMAY
DOIs
StatePublished - Jan 1 2019

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Stroke
Anti-Bacterial Agents
Infection
Pneumonia
Macrolides
Monobactams
Carbapenems
Aminoglycosides
Cephalosporins
Therapeutics
Penicillins
Anti-Inflammatory Agents
Retrospective Studies
Logistic Models

Keywords

  • Acute
  • Antibiotics
  • Post-stroke infections
  • Post-stroke pneumonia
  • Prognosis
  • Stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Antibiotic Class and Outcome in Post-stroke Infections : An individual participant data pooled analysis of VISTA-acute. / VISTA Collaboration and PISCES Group.

In: Frontiers in Neurology, Vol. 10, No. MAY, 504, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "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.",
keywords = "Acute, Antibiotics, Post-stroke infections, Post-stroke pneumonia, Prognosis, Stroke",
author = "{VISTA Collaboration and PISCES Group} and Smith, {Craig J.} and Calvin Heal and Andy Vail and Jeans, {Adam R.} and Westendorp, {Willeke F.} and Nederkoorn, {Paul J.} and {Van De Beek}, Diederik and Lalit Kalra and Joan Montaner and Mark Woodhead and Andreas Meisel and Lees, {K. R.} and A. Alexandrov and Bath, {P. M.} and E. Berge and E. Bluhmki and N. Bornstein and C. Chen and L. Claesson and Davis, {S. M.} and G. Donnan and Diener, {H. C.} and M. Fisher and Myron Ginsberg and B. Gregson and J. Grotta and W. Hacke and Hennerici, {M. G.} and M. Hommel and M. Kaste and P. Lyden and J. Marler and K. Muir and N. Venketasubramanian and Sacco, {Ralph L} and A. Shuaib and P. Teal and Wahlgren, {N. G.} and S. Warach and C. Weimar",
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T1 - Antibiotic Class and Outcome in Post-stroke Infections

T2 - An individual participant data pooled analysis of VISTA-acute

AU - VISTA Collaboration and PISCES Group

AU - Smith, Craig J.

AU - Heal, Calvin

AU - Vail, Andy

AU - Jeans, Adam R.

AU - Westendorp, Willeke F.

AU - Nederkoorn, Paul J.

AU - Van De Beek, Diederik

AU - Kalra, Lalit

AU - Montaner, Joan

AU - Woodhead, Mark

AU - Meisel, Andreas

AU - Lees, K. R.

AU - Alexandrov, A.

AU - Bath, P. M.

AU - Berge, E.

AU - Bluhmki, E.

AU - Bornstein, N.

AU - Chen, C.

AU - Claesson, L.

AU - Davis, S. M.

AU - Donnan, G.

AU - Diener, H. C.

AU - Fisher, M.

AU - Ginsberg, Myron

AU - Gregson, B.

AU - Grotta, J.

AU - Hacke, W.

AU - Hennerici, M. G.

AU - Hommel, M.

AU - Kaste, M.

AU - Lyden, P.

AU - Marler, J.

AU - Muir, K.

AU - Venketasubramanian, N.

AU - Sacco, Ralph L

AU - Shuaib, A.

AU - Teal, P.

AU - Wahlgren, N. G.

AU - Warach, S.

AU - Weimar, C.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

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.

KW - Acute

KW - Antibiotics

KW - Post-stroke infections

KW - Post-stroke pneumonia

KW - Prognosis

KW - Stroke

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DO - 10.3389/fneur.2019.00504

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