Infections Up to 76 Days After Stroke Increase Disability and Death

Learoyd, Annastazia E.; Woodhouse, Lisa J; Shaw, Laurence; Sprigg, Nikola; Bereczki, Dániel; Berge, Eivind; Caso, Valeria; Christensen, Hanne; Collins, Rónán; Członkowska, Anna; Etribi, A.; Farr, Tracy D.; Gommans, John; Laska, Ann‐Charlotte; Ntaios, George; Öztürk, Şerefnur; Pocock, Stuart J.; Prasad, Kameshwar; Wardlaw, Joanna M.; Fone, Kevin C. F.; Bath, Philip M; Trueman, Rebecca C.

doi:10.1007/s12975-017-0553-3

Cited by 34 publications

(31 citation statements)

References 41 publications

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“…Our study suggests that the incidence of SAI is nearly 30% among intracerebral hemorrhage patients, and that mortality is as high as 31.5% among such patients. These results are consistent with previous work 16,17 . Unfortunately, prophylactic use of antibiotics by patients with stroke does not appear to reduce occurrence of SAI 18 .…”

Section: Discussionsupporting

confidence: 94%

Excessive antibiotics use increased in-hospital mortality in intracerebral hemorrhage patients with stroke-associated infection

Wang

Shi

et al. 2020

Sci Rep

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intracerebral hemorrhage (icH) is associated with higher incidence of stroke-associated infection (SAi) as well as antibiotic use. However, there were few methods for judging proper antibiotic use in clinical manner. We introduce an index of antibiotic use, called personal antibiotic use density (PAUD), to evaluate the relation between antibiotic use and prognosis of ICH patients with SAI. A total of 162 in 570 ICH patients were observed to diagnose as SAI. Comparing with the survival patients, PAUD, ICH volume, National Institutes of Health Stroke Scale (NIHSS) score and ICH score were significantly higher among those who died, while the Glasgow Coma Scale score and the length of stay were significantly lower (p < 0.05). PAUD was identified as an independent risk factor of in-hospital death (OR 2.396, 95% CI 1.412-4.067, P = 0.001). In-hospital mortality was significantly lower in the low (P = 0.027) and intermediate PAUD (P < 0.001) groups than that in the high PAUD group. Cumulative in-hospital survival was significantly higher in low and intermediate PAUD groups (log rank test, P < 0.001). PAUD correlated positively with niHSS score (r = 0.224, P < 0.001) and in-hospital mortality (r = 0.268, p = 0.001). The study indicated that PAUD is closely related to in-hospital prognosis of ICH patients with SAI. Higher PAUD may not be associated with better prognosis, but instead, higher risk of death. Stroke-associated infection (SAI) 1 , also known as post-stroke infection, is defined as the absence of signs of infection at stroke and during infection latency, followed by infection within the first week after stroke 2. SAIs, such as pulmonary and urinary tract infections, are important complications of acute stroke. They complicate the disease and can worsen prognosis 3,4. In the clinical treatment of this type of patients, the use of antibiotics is extremely common, but adverse reactions 5 and antibiotic abuse can damage important organs and give rise to resistance, making treatment more difficult 6. Therefore, evaluation of antibiotic use is particularly important. Antibiotic use density (AUD) is a group-or population-level index that refers to the ratio of antibiotic consumption to the number of days that patients are hospitalized 7. AUD is often used in clinical economics 8. We propose here the concept of personal AUD (PAUD) to assess antibiotic use at the individual level. PAUD may better capture patients' use of antibiotics during hospitalization and the daily antibiotic load. It may be useful for evaluation of personal antibiotic use. Intracerebral hemorrhage is associated with higher mortality than other types of stroke 9 as well as higher incidence of SAI 10 and more common antibiotic use 11. The potential relationship between the use of antibiotics

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Section: Discussionsupporting

confidence: 94%

Excessive antibiotics use increased in-hospital mortality in intracerebral hemorrhage patients with stroke-associated infection

Wang

Shi

et al. 2020

Sci Rep

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“…Great effort has been invested into identifying risk factors, elucidating pathogenesis, and discovering implications for outcomes (2). Post-AIS infection has been identified as a key cause of death and prolonged hospitalization after stroke (3). Recent advances have demonstrated, for instance, that peripheral adaptive immunity is activated and recruited into the brain within the first few hours/days after AIS (4), and that its cells might regulate and be regulated by the gut microbiota (5).…”

Section: Introductionmentioning

confidence: 99%

Gut Microbiota in Acute Ischemic Stroke: From Pathophysiology to Therapeutic Implications

et al. 2020

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The microbiota-gut-brain axis is considered a central regulator of the immune system after acute ischemic stroke (AIS), with a potential role in determining outcome. Several pathways are involved in the evolution of gut microbiota dysbiosis after AIS. Brain-gut and gut-brain signaling pathways involve bidirectional communication between the hypothalamic-pituitary-adrenal axis, the autonomic nervous system, the enteric nervous system, and the immune cells of the gut. Alterations in gut microbiome can be a risk factor and may also lead to AIS. Both risk factors for AIS and gut-microbiome composition are influenced by similar factors, including diabetes, hypertension, hyperlipidemia, obesity, and vascular dysfunction. Furthermore, the systemic inflammatory response after AIS may yield liver, renal, respiratory, gastrointestinal, and cardiovascular impairment, including the multiple organ dysfunction syndrome. This review focus on biochemical, immunological, and neuroanatomical modulation of gut microbiota and its possible systemic harmful effects after AIS, as well as the role of ischemic stroke on microbiota composition. Finally, we highlight the role of gut microbiota as a potential novel therapeutic target in acute ischemic stroke.

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“…[1–3] It is also one of the most common leading causes of death around the world. [4–6] More importantly, those stroke survivors often suffer from lots of neurological deficits, such as limbs paralyze, physical and motor skills impairment, as well as the psychological conditions. [7–11] Of those disorders, cognitive impairment is one of the most common deficits caused by stroke.…”

Section: Introductionmentioning

confidence: 99%

Vinpocetine in the treatment of poststroke cognitive dysfunction

Liu

Yin

et al. 2019

Medicine

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Background: Previous clinical trials have reported that vinpocetine can be used for the treatment of cognitive dysfunction. However, its efficacy is still inconclusive. In this systematic review study, we aim to assess its efficacy and safety for the treatment of poststroke cognitive dysfunction (PSCD). Methods: We will search the following electronic databases from the inception to the present to evaluate the efficacy and safety of vinpocetine for patients with PSCD. These databases include CENTRAL, EMBASE, MEDILINE, CINAHL, AMED, and four Chinese databases. All randomized controlled trials (RCTs) of vinpocetine for PSCD will be considered for inclusion without the language restrictions. The methodological quality of all included RCTs will be evaluated by the Cochrane risk of bias tool. The 95% confidence intervals will be utilized to calculate the continuous data, the mean difference or standard mean difference, and dichotomous data with risk ratio. Dissemination and ethics: The results of this review will be disseminated through peer-reviewed journals. Its results may provide important evidence for the clinical practice, as well as the future studies. It does not require ethical approval, because this systematic review will not involve the individual data. Systematic review registration: PROSPERO CRD42018115224.

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Infections Up to 76 Days After Stroke Increase Disability and Death

Cited by 34 publications

References 41 publications

Excessive antibiotics use increased in-hospital mortality in intracerebral hemorrhage patients with stroke-associated infection

Excessive antibiotics use increased in-hospital mortality in intracerebral hemorrhage patients with stroke-associated infection

Gut Microbiota in Acute Ischemic Stroke: From Pathophysiology to Therapeutic Implications

Vinpocetine in the treatment of poststroke cognitive dysfunction

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