dc.contributor.author
Ulm, Lena
dc.contributor.author
Hoffmann, Sarah
dc.contributor.author
Nabavi, Darius
dc.contributor.author
Hermans, Marcella
dc.contributor.author
Mackert, Bruno-Marcel
dc.contributor.author
Hamilton, Frank
dc.contributor.author
Schmehl, Ingo
dc.contributor.author
Meisel, Christian [u.v.m.]
dc.date.accessioned
2018-06-08T10:42:50Z
dc.date.available
2017-05-19T11:35:28.002Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/20944
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-24242
dc.description.abstract
Background: Pneumonia is among the most common acute complications after
stroke and is associated with poor long-term outcome. Biomarkers may help
identifying stroke patients at high risk for developing stroke-associated
pneumonia (SAP) and to guide early treatment. Aims: This trial investigated
whether procalcitonin (PCT) ultrasensitive (PCTus)-guided antibiotic treatment
of SAP can improve functional outcome after stroke. Methods: In this
international, multicenter, randomized, controlled clinical trial with blinded
assessment of outcomes, patients with severe ischemic stroke in the middle
cerebral artery territory were randomly assigned within 40 h after symptom
onset to PCTus-based antibiotic therapy guidance in addition to stroke unit
care or standard stroke unit care alone. The primary endpoint was functional
outcome at 3 months, defined according to the modified Rankin Scale (mRS) and
dichotomized as acceptable (≤4) or unacceptable (≥5). Secondary endpoints
included usage of antibiotics, infection rates, days of fever, and mortality.
The trial was registered with http://ClinicalTrials.gov (Identifier
NCT01264549). Results: In the intention-to-treat-analysis based on 227
patients (112 in PCT and 115 in control group), 197 patients completed the
3-month follow-up. Adherence to PCT guidance was 65%. PCT-guided therapy did
not improve functional outcome as measured by mRS (odds ratio 0.79; 95%
confidence interval 0.45–1.35, p = 0.47). Pneumonia rate and mortality were
similar in both groups. Days with fever tended to be lower (p = 0.055),
whereas total number of days treated with antibiotics were higher (p = 0.004)
in PCT compared to control group. A post hoc analysis including all PCT values
in the intention-to-treat population demonstrated a significant increase on
the first day of infection in patients with pneumonia and sepsis compared to
patients with urinary tract infections or without infections (p < 0.0001).
Conclusion: PCTus-guided antibiotic therapy did not improve functional outcome
at 3 months after severe ischemic stroke. PCT is a promising biomarker for
early detection of pneumonia and sepsis in acute stroke patients.
en
dc.rights.uri
http://creativecommons.org/licenses/by/4.0/
dc.subject
antibiotic prophylaxis
dc.subject
biomarker-guided treatment
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit
dc.title
The Randomized Controlled STRAWINSKI Trial
dc.type
Wissenschaftlicher Artikel
dc.title.subtitle
Procalcitonin-Guided Antibiotic Therapy after Stroke
dcterms.bibliographicCitation.doi
10.3389/fneur.2017.00153
dcterms.bibliographicCitation.url
http://doi.org/10.3389/fneur.2017.00153
refubium.affiliation
Charité - Universitätsmedizin Berlin
de
refubium.mycore.fudocsId
FUDOCS_document_000000027040
refubium.note.author
Der Artikel wurde in einer reinen Open-Access-Zeitschrift publiziert.
refubium.resourceType.isindependentpub
no
refubium.mycore.derivateId
FUDOCS_derivate_000000008219
dcterms.accessRights.openaire
open access