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The Randomized Controlled STRAWINSKI Trial
Ulm, Lena ;  Hoffmann, Sarah ;  Nabavi, Darius ;  Hermans, Marcella ;  Mackert, Bruno-Marcel ;  Hamilton, Frank ;  Schmehl, Ingo ;  Meisel, Christian [u.v.m.]

HaupttitelThe Randomized Controlled STRAWINSKI Trial
TitelzusatzProcalcitonin-Guided Antibiotic Therapy after Stroke
AutorUlm, Lena
AutorHoffmann, Sarah
AutorNabavi, Darius
AutorHermans, Marcella
AutorMackert, Bruno-Marcel
AutorHamilton, Frank
AutorSchmehl, Ingo
AutorMeisel, Christian [u.v.m.]
Seitenzahl10 S.
Freie Schlagwörterstroke; pneumonia; antibiotic prophylaxis; procalcitonin; outcome; infections; biomarker-guided treatment
DDC610 Medizin und Gesundheit
Auch erschienen in
ZusammenfassungBackground: 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.
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Fachbereich/EinrichtungMedizinische Fakultät Charité - Universitätsmedizin Berlin
Erscheinungsjahr2017
Dokumententyp/-SammlungenWissenschaftlicher Artikel
SpracheEnglisch
RechteCreative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Anmerkungen des AutorsDer Artikel wurde in einer reinen Open-Access-Zeitschrift publiziert.
Erstellt am19.05.2017 - 11:34:14
Letzte Änderung19.05.2017 - 11:35:28
 
Statische URLhttp://edocs.fu-berlin.de/docs/receive/FUDOCS_document_000000027040
DOI10.3389/fneur.2017.00153
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