Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial.
Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial.
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DOI：
10.1371/journal.pone.0002158
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发表时间：
2008-05-14
期刊：
影响因子：
3.7
通讯作者：
Meisel A
中科院分区：
文献类型：
--
作者：
Harms H;Prass K;Meisel C;Klehmet J;Rogge W;Drenckhahn C;Göhler J;Bereswill S;Göbel U;Wernecke KD;Wolf T;Arnold G;Halle E;Volk HD;Dirnagl U;Meisel A
肺炎是急性脑卒中后死亡的主要危险因素。在小鼠模型中，使用利福沙星的预防性抗菌治疗不仅可以预防卒中后感染的发生，还可以降低死亡率，并显着改善神经功能结局。在这项研究中，我们调查这种方法是否对中风患者有效。急性缺血性卒中的预防性抗菌治疗（PANTHERIS）是一项随机、双盲、安慰剂对照试验，在80例大脑中动脉（MCA）区域的重度、非腔隙性、缺血性卒中（NIHSS>11）患者中进行。患者在卒中发作后36小时内开始接受静脉注射阿托沙星（每日400 mg）或安慰剂5天。主要终点为11天内感染。次要终点包括神经学结局、生存率、卒中诱导的免疫抑制的发生和细菌耐药性的诱导。在意向治疗分析（79例患者）中，阿托沙星治疗组第11天的感染率为15.4%，而安慰剂治疗组为32.5%（p = 0.114）。 在符合方案分析（n = 66）中，阿托沙星使感染率从41.9%显著降低至17.1%（p = 0.032）。 卒中相关感染与较低的存活率相关。在这项研究中，莫西沙星治疗对神经系统结局和生存率没有显着影响。两个治疗组的氟喹诺酮耐药频率没有差异。在逻辑回归分析中，治疗组以及治疗组与卒中发作后第1天单核细胞HLA-DR表达（免疫抑制的标志物）之间的相互作用独立且高度预测卒中后感染。PANTHERIS提示，与安慰剂相比，预防性给予利福沙星在减少严重非腔隙性缺血性卒中后感染方面具有上级优势。此外，研究结果强调了免疫抑制在中风后感染中的关键作用。Controlled-Trials.com www.example.com
Pneumonia is a major risk factor of death after acute stroke. In a mouse model, preventive antibacterial therapy with moxifloxacin not only prevents the development of post-stroke infections, it also reduces mortality, and improves neurological outcome significantly. In this study we investigate whether this approach is effective in stroke patients. Preventive ANtibacterial THERapy in acute Ischemic Stroke (PANTHERIS) is a randomized, double-blind, placebo-controlled trial in 80 patients with severe, non-lacunar, ischemic stroke (NIHSS>11) in the middle cerebral artery (MCA) territory. Patients received either intravenous moxifloxacin (400 mg daily) or placebo for 5 days starting within 36 hours after stroke onset. Primary endpoint was infection within 11 days. Secondary endpoints included neurological outcome, survival, development of stroke-induced immunodepression, and induction of bacterial resistance. On intention-to treat analysis (79 patients), the infection rate at day 11 in the moxifloxacin treated group was 15.4% compared to 32.5% in the placebo treated group (p = 0.114). On per protocol analysis (n = 66), moxifloxacin significantly reduced infection rate from 41.9% to 17.1% (p = 0.032). Stroke associated infections were associated with a lower survival rate. In this study, neurological outcome and survival were not significantly influenced by treatment with moxifloxacin. Frequency of fluoroquinolone resistance in both treatment groups did not differ. On logistic regression analysis, treatment arm as well as the interaction between treatment arm and monocytic HLA-DR expression (a marker for immunodepression) at day 1 after stroke onset was independently and highly predictive for post-stroke infections. PANTHERIS suggests that preventive administration of moxifloxacin is superior in reducing infections after severe non-lacunar ischemic stroke compared to placebo. In addition, the results emphasize the pivotal role of immunodepression in developing post-stroke infections. Controlled-Trials.com ISRCTN74386719
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影响因子：
8.3
作者：
Davenport, RJ;Dennis, MS;Warlow, CP
通讯作者：
Warlow, CP
影响因子：
9.9
作者：
DEPIPPO, KL;HOLAS, MA;LESSER, ML
通讯作者：
LESSER, ML
DOI：
10.1016/s0003-9993(98)90415-4
发表时间：
1998-12-01
影响因子：
4.3
作者：
Kong, KH;Chua, KSG;Tow, AP
通讯作者：
Tow, AP
影响因子：
168.9
作者：
Clarke, J;Cranswick, G;Warlow, C
通讯作者：
Warlow, C
影响因子：
8.3
作者：
HENON, H;GODEFROY, O;PRUVO, JP
通讯作者：
PRUVO, JP