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Preventive antibiotic treatment stroke

Victoria Ewan, Thomas Hellyer, Julia Newton, John Simpson
Approximately 1.5% of hospital patients develop hospital acquired pneumonia. Aspiration is the major risk factor for pneumonia and is associated with reduced ability to mechanically clear respiratory pathogens into the stomach. Currently non-invasive methods of diagnosing hospital acquired pneumonia are less robust than invasive methods, and lead to over-diagnosis. Accurate diagnosis is key to surveillance, prevention and treatment of HAP, and also to improving outcomes; newer imaging modalities such as phase contrast X-ray imaging and nanoparticle enhanced magnetic resonance imaging may help...
February 27, 2017: Age and Ageing
Willeke F Westendorp, Jan-Dirk Vermeij, Matthijs C Brouwer, Y B W E M Roos, Paul J Nederkoorn, Diederik van de Beek
BACKGROUND: Stroke-associated infections occur frequently and are associated with unfavorable outcome. Previous cohort studies suggest a protective effect of beta-blockers (BBs) against infections. A sympathetic drive may increase immune suppression and infections. AIM: This study is aimed at investigating the association between BB treatment at baseline and post-stroke infection in the Preventive Antibiotics in Stroke Study (PASS), a prospective clinical trial...
2016: Cerebrovascular Diseases
Carlo Caffarelli, Francesca Santamaria, Dora Di Mauro, Carla Mastrorilli, Virginia Mirra, Sergio Bernasconi
This review focuses key advances in different pediatric fields that were published in Italian Journal of Pediatrics and in international journals in 2015. Weaning studies continue to show promise for preventing food allergy. New diagnostic tools are available for identifying the allergic origin of allergic-like symptoms. Advances have been reported in obesity, short stature and autoimmune endocrine disorders. New molecules are offered to reduce weight gain and insulin-resistance in obese children. Regional investigations may provide suggestions for preventing short stature...
August 27, 2016: Italian Journal of Pediatrics
Diana Amantea, Michelangelo Certo, Francesco Petrelli, Giacinto Bagetta
Repurposing the macrolide antibiotic azithromycin has recently been suggested as a promising neuroprotective strategy for the acute treatment of ischemic stroke. Here, we aim at further characterizing the immunomodulatory properties of intraperitoneal (i.p.) administration of this drug and, more importantly, at assessing whether neuroprotection can also be achieved by the more clinically relevant intravenous (i.v.) route of administration in a mouse model of focal cerebral ischemia induced by transient (30-min) middle cerebral artery occlusion (MCAo)...
July 8, 2016: Assay and Drug Development Technologies
Jan-Dirk Vermeij, Willeke F Westendorp, Yvo B Roos, Matthijs C Brouwer, Diederik van de Beek, Paul J Nederkoorn
BACKGROUND: The Preventive Antibiotics in Stroke Study (PASS), a randomized open-label masked endpoint trial, showed that preventive ceftriaxone did not improve functional outcome at 3 months in patients with acute stroke (adjusted common OR 0.95; 95% CI 0.82-1.09). Post-hoc analyses showed that among patients who received intravenous thrombolysis (IVT), patients who received ceftriaxone had a significantly better outcome as compared with the control group. This study aimed to gain more insight into the characteristics of these patients...
2016: Cerebrovascular Diseases
J Hitzeroth, N Beckett, P Ntuli
Although infective endocarditis (IE) is relatively uncommon, it remains an important clinical entity with a high in-hospital and 1-year mortality. It is most commonly caused by viridans streptococci. Staphylococcus aureus is responsible for a malignant course of IE and often requires early surgery to eradicate. Other rarer causes are various bacilli, including the HACEK (Haemophilus, Actinobacillus,Cardiobacterium, Eikenella and Kingella spp.) group of organisms and fungi. The clinical presentation varies. Patients may present with a nonspecific illness, valve dysfunction, heart failure (HF) and symptoms due to peripheral embolisation...
February 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
S Sinoy, S M Fayaz, K D Charles, V K Suvanish, Josef P Kapfhammer, G K Rajanikant
MicroRNAs (miRNAs) are a group of small non-coding RNAs that regulate numerous signaling pathways involved in cerebral ischemia reperfusion injury. Recent finding demonstrated that miR-497 promotes ischemic neuronal death by negatively regulating anti-apoptotic proteins and therefore serves as a promising therapeutic target for cerebral ischemic injury. In this study, we present a systematic computational approach that includes 3D modeling, docking-based virtual screening, and molecular dynamics simulation to identify small-molecule inhibitors of pre-miR-497 maturation...
May 21, 2016: Molecular Neurobiology
Arfah Hazel Preston, Stefan Williams, Judy Archer
Stroke is a common embolic complication of infective endocarditis. The most important treatment to prevent stroke in endocarditis is the initiation of antibiotic therapy. It is unclear whether the initiation of de novo anticoagulation (i.e, warfarin) in patients with infective endocarditis is beneficial, since there are no large or randomized controlled trials in this area. However, this case report suggests, despite the limited evidence, that anticoagulation in this patient caused no harm and could suggest a hint of possible benefit...
May 2016: Clinical Case Reports
Katarzyna Winek, Odilo Engel, Priscilla Koduah, Markus M Heimesaat, André Fischer, Stefan Bereswill, Claudia Dames, Olivia Kershaw, Achim D Gruber, Caterina Curato, Naoki Oyama, Christian Meisel, Andreas Meisel, Ulrich Dirnagl
BACKGROUND AND PURPOSE: Antibiotics disturbing microbiota are often used in treatment of poststroke infections. A bidirectional brain-gut microbiota axis was recently suggested as a modulator of nervous system diseases. We hypothesized that gut microbiota may be an important player in the course of stroke. METHODS: We investigated the outcome of focal cerebral ischemia in C57BL/6J mice after an 8-week decontamination with quintuple broad-spectrum antibiotic cocktail...
May 2016: Stroke; a Journal of Cerebral Circulation
Waqar Waheed, Muriel H Nathan, Gilman B Allen, Neil M Borden, M Ali Babi, Rup Tandan
A 37-year-old man with a known history of neurofibromatosis 1 (NF1) presented within 2 days of diarrhoeal illness followed by encephalopathy, facial twitching, hypoglycaemia, hypotension, tachycardia and low-grade fever. Examination showed multiple café-au-lait spots and neurofibromas over the trunk, arms and legs and receptive aphasia with right homonymous hemianopia, which resolved. Workup for cardiac, inflammatory and infectious aetiologies was unrevealing. A brain MRI showed gyral swelling with increased T2 fluid-attenuated inversion recovery signal and diffusion restriction in the left cerebral cortex...
2015: BMJ Case Reports
Lalit Kalra, Saddif Irshad, John Hodsoll, Matthew Simpson, Martin Gulliford, David Smithard, Anita Patel, Irene Rebollo-Mesa
BACKGROUND: Post-stroke pneumonia is associated with increased mortality and poor functional outcomes. This study assessed the effectiveness of antibiotic prophylaxis for reducing pneumonia in patients with dysphagia after acute stroke. METHODS: We did a prospective, multicentre, cluster-randomised, open-label controlled trial with masked endpoint assessment of patients older than 18 years with dysphagia after new stroke recruited from 48 stroke units in the UK, accredited and included in the UK National Stroke Audit...
November 7, 2015: Lancet
Amanda Beaudoin, Laura Edison, Camille E Introcaso, Lucy Goh, James Marrone, Amelita Mejia, Chris Van Beneden
Acute rheumatic fever is a nonsuppurative, immune-mediated consequence of group A streptococcal pharyngitis (strep throat). Recurrent or severe acute rheumatic fever can cause permanent cardiac valve damage and rheumatic heart disease, which increases the risk for cardiac conditions (e.g., infective endocarditis, stroke, and congestive heart failure). Antibiotics can prevent acute rheumatic fever if administered no more than 9 days after symptom onset. Long-term benzathine penicillin G (BPG) injections are effective in preventing recurrent acute rheumatic fever attacks and are recommended to be administered every 3-4 weeks for 10 years or until age 21 years to children who receive a diagnosis of acute rheumatic fever...
May 29, 2015: MMWR. Morbidity and Mortality Weekly Report
Chia-Lun Chou, Woan-Ruoh Lee, Chun-Chieh Yeh, Chun-Chuan Shih, Ta-Liang Chen, Chien-Chang Liao
BACKGROUND: Postoperative adverse outcomes in patients with pressure ulcer are not completely understood. This study evaluated the association between preoperative pressure ulcer and adverse events after major surgeries. METHODS: Using reimbursement claims from Taiwan's National Health Insurance Research Database, we conducted a nationwide retrospective cohort study of 17391 patients with preoperative pressure ulcer receiving major surgery in 2008-2010. With a propensity score matching procedure, 17391 surgical patients without pressure ulcer were selected for comparison...
2015: PloS One
Janet K Sluggett, Gillian E Caughey, Michael B Ward, Andrew L Gilbert
BACKGROUND: Guidelines recommend patients diagnosed with transient ischaemic attack (TIA) or ischaemic stroke receive antihypertensive, antithrombotic and lipid lowering medicines. Reassessment of the need for medicines associated with an increased risk of stroke is also recommended. OBJECTIVE: To determine changes in the use of medicines recommended for secondary stroke prevention, medicines commonly used for treating stroke-related complications and medicines not recommended for use after ischaemic stroke, and to determine patient characteristics associated with use of all three stroke prevention medicines after TIA or ischaemic stroke...
October 2015: International Journal of Clinical Pharmacy
M A Kutlubaev
Pneumonia and urinary tract infections develop in roughly 1/3 of the survivors of cerebral stroke. Post-stroke pneumonia results from aspiration and uroinfection from neurogenic disturbances of urination and bladder catheterization. Post-stroke immune deficiency increases the risk of infectious and inflammatory complications. These conditions are treated in accordance with the general principles of management of these diseases. Prophylaxis of pneumonia is reduced to the principle of "nothing orally" before the swallowing capacity is tested, early mobilization, and oral cavity hygiene...
2014: Klinicheskaia Meditsina
Maaike Dirks, Thomas P Zonneveld, Diederik W J Dippel, Paul J Nederkoorn, Diederik van de Beek, Robert J van Oostenbrugge, Nyika D Kruyt
OBJECTIVES: We investigated whether an active blood pressure-lowering strategy is associated with more patients receiving thrombolytics compared with a conservative "watch and measure" strategy, and assessed safety and functional outcome of these 2 treatment strategies. METHODS: This is a post hoc analysis in 2 randomized controlled stroke trials, the PRACTISE (Promoting Acute Thrombolysis in Ischemic Stroke) and the PASS (Preventive Antibiotics in Stroke Study)...
April 7, 2015: Neurology
Hans Worthmann, Anita B Tryc, Meike Dirks, Ramona Schuppner, Korbinian Brand, Frank Klawonn, Ralf Lichtinghagen, Karin Weissenborn
BACKGROUND: Ischemic stroke patients are prone to infection by stroke-induced immunodepression. We hypothesized that levels of lipopolysaccharide binding protein (LBP), interleukin-10 (IL-10), IL-6 and C-reactive protein (CRP) are early predictors for the development of stroke-associated infection. METHODS: Fifty-six patients with ischemic stroke (n = 51) and transient ischemic attack (TIA) (n = 5) who presented within 6 hours after symptom onset and who were free of detectable infection on admission were included in the study...
2015: Journal of Neuroinflammation
Willeke F Westendorp, Jan-Dirk Vermeij, Elles Zock, Imke J Hooijenga, Nyika D Kruyt, Hans J L W Bosboom, Vincent I H Kwa, Martijn Weisfelt, Michel J M Remmers, Robert ten Houten, A H C M Tobien Schreuder, Sarah E Vermeer, Ewout J van Dijk, Diederik W J Dippel, Marcel G W Dijkgraaf, Lodewijk Spanjaard, Marinus Vermeulen, Tom van der Poll, Jan M Prins, Frederique H Vermeij, Yvo B W E M Roos, Ruud P Kleyweg, Henk Kerkhoff, Matthijs C Brouwer, Aeilko H Zwinderman, Diederik van de Beek, Paul J Nederkoorn
BACKGROUND: In adults with acute stroke, infections occur commonly and are associated with an unfavourable functional outcome. In the Preventive Antibiotics in Stroke Study (PASS) we aimed to establish whether or not preventive antimicrobial therapy with a third-generation cephalosporin, ceftriaxone, improves functional outcome in patients with acute stroke. METHODS: In this multicentre, randomised, open-label trial with masked endpoint assessment, patients with acute stroke were randomly assigned to intravenous ceftriaxone at a dose of 2 g, given every 24 h intravenously for 4 days, in addition to stroke unit care, or standard stroke unit care without preventive antimicrobial therapy; assignments were made within 24 h after symptom onset...
April 18, 2015: Lancet
Yevgeniy Khariton, John A House, Lynn Comer, Tina R Coggins, Anthony Magalski, David G Skolnick, Thomas H Good, Michael L Main
Transesophageal echocardiography (TEE) is frequently performed in patients with acute ischemic cerebrovascular events to exclude a cardioembolic source. We aimed to determine the clinical impact of TEE on management. This is a retrospective single-center study of 1,458 consecutive patients hospitalized with acute ischemic stroke or transient ischemic attack who underwent TEE for evaluation of a suspected cardioembolic cause. Significant TEE findings were determined for each patient as recorded on the TEE report...
December 15, 2014: American Journal of Cardiology
Jochen Springer, Susanne Schust, Katrin Peske, Anika Tschirner, Andre Rex, Odilo Engel, Nadja Scherbakov, Andreas Meisel, Stephan von Haehling, Michael Boschmann, Stefan D Anker, Ulrich Dirnagl, Wolfram Doehner
BACKGROUND AND PURPOSE: Muscle wasting is a common complication accompanying stroke. Although it is known to impair poststroke recovery, the mechanisms of subacute catabolism after stroke have not been investigated in detail. The aim of this study is to investigate mechanisms of local and systemic catabolism and muscle wasting (sarcopenia) in a model of ischemic stroke systematically. METHODS: Changes in body composition and catabolic activation in muscle tissue were studied in a mouse model of acute cerebral ischemia (temporal occlusion of the middle cerebral artery)...
December 2014: Stroke; a Journal of Cerebral Circulation
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