Introduction
Acute stroke is a cerebrovascular
disease. Infections are common severe complications after stroke , and
the incidence of post-stroke infection is approximately 30% among
patients with acute stroke. 1 Pneumonia and urinary
tract infections are the most common stroke-related infections,2 and these infections are associated with higher
morbidity and mortality. 3There are multiple risk factors
for post-stroke infections, including elder, dysphagia, stroke severity,
dependency, congestive cardiac failure, increased postvoid residual
(PVR) volume, higher modified Rankin scale (mRS) score, and postischemic
immune activation. 2,4,5 A meta-analysis showed that
post-stroke infections accounted for over 48% of mortality among the
patients with stroke, while the mortality rate was 18% among those
without post-stroke infection. 1 And it was reported
that the mRS score and disability rate were significantly increased in
patients with stroke-related infections. 5,6
The
previous Cochrane review and meta-analysis revealed that prophylactic
antibiotics reduced the incidence of infections and urinary tract
infections in post-stroke patients, but couldn’t reduce the mortality
rate and incidence of pneumonia.7,8 However, a randomized controlled trial (RCT)
recently published afterwards showed that prophylactic antibiotics
decreased the mortality rate and the incidence of early-onset
ventilator-associated pneumonia in patients with acute stroke,9 which were inconsistent
with previous RCTs.10-12 Therefore, prophylactic antibiotics in stroke
patients remains a controversial issue.
Thus, we performed this
meta-analysis of all RCTs to determine the efficacy and safety of
prophylactic antibiotics in stroke patients, and provide recommendations
for clinical practice as well as the development of relevant guidelines.