Preventive Antibiotics in Stroke Study (PASS)

Westendorp, Willeke F.; Zock, Elles; Vermeij, Jan-Dirk; Kerkhoff, Henk; Nederkoorn, Paul J.; Dijkgraaf, Marcel G. W.; Beek, Diederik van de

doi:10.1212/wnl.0000000000005412

Cited by 13 publications

(22 citation statements)

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“…One of the largest studies, which included 19,063 first-time stroke patients, indicated that the risk of stroke was highest during the first 3 days after the diagnosis of respiratory tract infection (IR = 3.19 95%CI 2.81-3.62) or urinary tract infection (IR = 2.72 95%CI 2.32-3.20). However, in the following PASS (preventive antibiotics in stroke study), preventive ceftriaxone did not improve functional outcomes in patients with acute stroke [37]. In our study, the most significant infections were Helicobacter pylori(HP), virus and certain atypical microorganisms, including amoebiasis, legionellosis and vibrio cholerase, which were not covered by ceftriaxone.…”

Section: Discussioncontrasting

confidence: 57%

Identification of novel biomarkers in ischemic stroke: a genome-wide integrated analysis

et al. 2020

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Background: Ischemic Stroke (IS) is the most common neurological emergency disease and has become the second most frequent cause of death after coronary artery disease in 2015. Owing to its high fatality rate and narrow therapeutic time window, early identification and prevention of potential stroke is becoming increasingly important. Methods: We used meta-analysis and bioinformatics mining to explore disease-related pathways and regulatory networks after combining messengerRNA (mRNA) and miRNA expression analyses. The purpose of our study was to screen for candidate target genes and microRNA(miRNA) for early diagnosis of potential stroke. Results: Five datasets were collected from the Gene Expression Omnibus (GEO) database by systematical retrieval, which contained three mRNA datasets (102 peripheral blood samples in total) and two miRNA dataset (59 peripheral blood samples). Approximately 221 different expression(DE) mRNAs (155 upregulated and 66 downregulated mRNAs) and 185 DE miRNAs were obtained using the metaDE package and GEO2R tools. Further functional enrichments of DE-mRNA, DE-miRNA and protein-protein interaction (PPI) were performed and visualized using Cytoscape. Conclusion: Our study identified six core mRNAs and two regulated miRNAs in the pathogenesis of stroke, and we elaborated the intrinsic role of systemic lupus erythematosus (SLE) and atypical infections in stroke, which may aid in the development of precision medicine for treating ischemic stroke. However, the role of these novel biomarkers and the underlying molecular mechanisms in IS require further fundamental experiments and further clinical evidence.

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Section: Discussioncontrasting

confidence: 57%

Identification of novel biomarkers in ischemic stroke: a genome-wide integrated analysis

et al. 2020

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“…A recent cost-effectiveness study of PASS showed that three months after stroke, the number of quality-adjusted life years (QALYs) was significantly higher in the ceftriaxone-treated patients, compared with the control group ( p = 0.006) and that preventive ceftriaxone in adults with acute stroke is indeed cost-effective. 43 Whether costs justify the increasing use of antibiotics, however, remains subject of debate.…”

Section: Future Directions: “Can We Conclude That No Further Researchmentioning

confidence: 99%

Post-stroke infections and preventive antibiotics in stroke: Update of clinical evidence

Vermeij

Westendorp

Beek

et al. 2018

International Journal of Stroke

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This review provides an update of evidence on post-stroke infections and the use of preventive antibiotics in stroke. Infection is a common complication after stroke, affecting between 15% and 30% of the patients. The predictors for post-stroke infection can be divided into three categories: clinical factors, anatomical (stroke related) factors and immunological factors. The relation between the occurrence of a post-stroke infection and functional outcome remained subject of debate, but it seems likely that the occurrence of these infections has a causal relation with poor functional outcome and mortality. In the first meta-analysis on preventive antibiotic therapy, almost a decade ago, its beneficial effect on post-stroke infection rate was clear; however, the effect on functional outcome remained uncertain because included studies were small and heterogeneous. Afterwards, three large phase-3 RCTs were published and a Cochrane meta-analysis was performed. It has now become clear that, despite the finding that overall infections are reduced, preventive antibiotic therapy in the acute phase of stroke does neither improve functional outcome, nor decrease mortality rates. This does not yet mean that further research on preventive antibiotics in stroke is useless: the pathophysiology and etiology of post-stroke infections are unclear and the use of preventive antibiotics in specific subgroups of stroke patients could still be very effective. This is currently being studied. Besides, preventive antibiotic therapy might be cost-effective by increasing quality-adjusted life years. Thirdly, research for the upcoming years might put more emphasis on the effect of stroke on immunological alterations.

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“…Amelia Boehme, PhD, contributes a blog titled "Prophylactic antibiotic use in stroke patients," in reference to the article by Westerndorp et al, 1 "Preventive Antibiotics in Stroke Study (PASS): A cost-effectiveness study," about ceftriaxone vs standard stroke unit care without preventive antibiotics therapy. In the primary publication of PASS, prophylactic ceftriaxone did not improve the modified Rankin Scale score at 3 months.…”

Section: Editors' Blogmentioning

confidence: 99%

What's happening in Innovations in Care Delivery

2018

Neurology

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Innovations in Care Delivery strives to highlight articles that feature advances in care delivery in our Editor's blog, Editor's top 5 recommended reading, and Latest articles section. Periodically, we also include interviews with leaders in the field of health services research. Blog Read the Innovations in Care Delivery blog for timely posts by the editors and invited guests on Neurology articles. NPub.org/icdblog

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Preventive Antibiotics in Stroke Study (PASS)

Abstract: Preventive ceftriaxone has a probability of 0.7 of being less costly than standard treatment per unit decrease in mRS and per QALY gained.

Cited by 13 publications

References 13 publications

Identification of novel biomarkers in ischemic stroke: a genome-wide integrated analysis

Identification of novel biomarkers in ischemic stroke: a genome-wide integrated analysis

Post-stroke infections and preventive antibiotics in stroke: Update of clinical evidence

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