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.