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dc.contributorVall d'Hebron Barcelona Hospital Campus
dc.contributor.authorSmith, Craig J
dc.contributor.authorHeal, Calvin
dc.contributor.authorVail, Andy
dc.contributor.authorJeans, Adam R
dc.contributor.authorWestendorp, Willeke F
dc.contributor.authorNederkoorn, Paul J
dc.contributor.authorMontaner Villalonga, Joan
dc.date.accessioned2019-08-20T05:53:28Z
dc.date.available2019-08-20T05:53:28Z
dc.date.issued2019-05-14
dc.identifier.citationSmith CJ, Heal C, Vail A, Jeans AR, Westendorp WF, Nederkoorn PJ, et al. Antibiotic Class and Outcome in Post-stroke Infections: An Individual Participant Data Pooled Analysis of VISTA-Acute. Front Neurol. 2019;10:504.
dc.identifier.issn1664-2295
dc.identifier.urihttp://hdl.handle.net/11351/4263
dc.descriptionAntibióticos; Infecciones posteriores a un accidente cerebrovascular; Neumonía posterior a un accidente cerebrovascular
dc.description.abstractIntroduction: 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.
dc.language.isoeng
dc.publisherFrontiers Media
dc.relation.ispartofseriesFrontiers in Neurology;10
dc.rightsAttribution 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.sourceScientia
dc.subjectMalalties cerebrovasculars - Complicacions
dc.subjectInfecció
dc.subjectAntibiòtics
dc.subjectAvaluació de resultats (Assistència mèdica)
dc.subject.meshStroke
dc.subject.mesh/complications
dc.subject.meshInfection
dc.subject.mesh/pharmacology
dc.subject.meshAnti-Bacterial Agents
dc.subject.meshRetrospective Studies
dc.titleAntibiotic Class and Outcome in Post-stroke Infections: An Individual Participant Data Pooled Analysis of VISTA-Acute
dc.typeinfo:eu-repo/semantics/article
dc.identifier.doi10.3389/fneur.2019.00504
dc.subject.decsaccidente cerebrovascular
dc.subject.decs/complicaciones
dc.subject.decsinfección
dc.subject.decs/farmacología
dc.subject.decsantibacterianos
dc.subject.decsestudios retrospectivos
dc.relation.publishversionhttps://www.frontiersin.org/articles/10.3389/fneur.2019.00504/full
dc.type.versioninfo:eu-repo/semantics/publishedVersion
dc.audienceProfessionals
dc.contributor.organismesInstitut Català de la Salut
dc.contributor.authoraffiliation[Smith CJ] Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, United Kingdom. Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom. [Heal C, Vail A] Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom. [Jeans AR] Division of Clinical Support Services and Tertiary Medicine, Department of Microbiology, Salford Royal NHS Foundation Trust, Salford, United Kingdom. [Westendorp WF, Nederkoorn PJ] Department of Neurology, Amsterdam Neuroscience, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. [Montaner J] Laboratori en Recerca Neurovascular, Vall d’Hebron Institut de Recerca, Barcelona, Spain. Stroke Research Program, Department of Neurology, Institute de Biomedicine of Seville, Seville, Spain. Hospital Universitario Virgen Macarena, Seville, Spain. IBiS Seville, Spain. Hospital Universitario Virgen del Rocío Seville, Spain. CSIC Seville, Spain. University of Seville, Seville, Spain
dc.identifier.pmid31156537
dc.identifier.wosWOS:000467863700001
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess


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