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Correspondence Prophylactic antibiotics to reduce pneumonia after acute stroke
The STROKE-INF trial (Nov 7, p1835)1 reported outcomes that were different from those initially included in the ISRCTN registry (number ISRCTN37118456). There were two pre-specified primary outcomes, of which one was reported in the Article, and the other (“total hospital costs”) was not reported anywhere in the paper. In addition, the Article reported a new co-primary outcome (“physician diagnosed post-stroke pneumonia”) that was not pre-specified, without declaring it as such. Of the 14 pre-specified secondary outcomes, six were reported in the paper, and eight were unreported anywhere in the paper.
Source: LANCET - January 30, 2016 Category: Journals (General) Authors: Ioan Milosevic, Aaron Dale, Henry Drysdale, Kamal Mahtani, COMPare project team Tags: Correspondence Source Type: research

Correspondence Prophylactic antibiotics to reduce pneumonia after acute stroke – Author's reply
Ioan Milosevic and colleagues pointed out that the outcomes presented in our Article1 were different from those in the ISRCTN registry (number ISRCTN37118456). They stated that one pre-specified primary outcome (“hospital costs”) was not reported, and a new co-primary outcome (“physician diagnosed post-stroke pneumonia”) added. We have clarified in the Methods section that physician diagnosed pneumonia was not a primary outcome but was presented as an alternative to algorithm-based diagnosis to harmonise with diagnostic criteria used in previous studies.
Source: LANCET - January 30, 2016 Category: Journals (General) Authors: Lalit Kalra Tags: Correspondence Source Type: research

Articles Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial
Antibiotic prophylaxis cannot be recommended for prevention of post-stroke pneumonia in patients with dysphagia after stroke managed in stroke units.
Source: LANCET - September 3, 2015 Category: Journals (General) Authors: Lalit Kalra, Saddif Irshad, John Hodsoll, Matthew Simpson, Martin Gulliford, David Smithard, Anita Patel, Irene Rebollo-Mesa, STROKE-INF Investigators Tags: Articles Source Type: research

Comment Prevention of stroke-associated pneumonia: where next?
Prevention and treatment of complications, such as infection, are a mainstay of post-stroke care.1,2 However, even with dedicated care in a stroke unit, disorders such as stroke-associated pneumonia are a major challenge;2,3 and since this disorder is a substantial contributor to mortality and morbidity after stroke, new therapeutic approaches are urgently needed.3,4 Experimental studies and phase 2b randomised controlled trials5,6 raised hope that preventive anti-infective treatment with antibiotics might not only control infections, but also improve outcomes after stroke.
Source: LANCET - September 3, 2015 Category: Journals (General) Authors: Andreas Meisel, Craig J Smith Tags: Comment Source Type: research

Correspondence Parenteral antibiotics are not enough to prevent pneumonia in stroke
The Preventive Antibiotics in Stroke Study (PASS; April 18, p 1519)1 reported that parenteral ceftriaxone did not significantly reduce pneumonia. We would like to comment on these results.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Luciano Silvestri, Hendrick K F van Saene, Marco Milanese, Silvia Ros, Durk F Zandstra Tags: Correspondence Source Type: research

Correspondence Parenteral antibiotics are not enough to prevent pneumonia in stroke – Authors' reply
The susceptibility of patients with stroke to pneumonia has been well recognised,1 and its cause is multifactorial.2 Luciano Silvestri and colleagues rightly point out pathophysiological differences between early pneumonia after stroke, defined as within the first week after stroke onset, and late pneumonia, defined as after the first week. The Pneumonia In Stroke ConsEnsuS (PISCES) group has recently recommended reserving the term stroke-associated pneumonia for the spectrum of lower respiratory tract infections within the first 7 days after stroke onset.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Diederik van de Beek, Matthijs Brouwer, Paul Nederkoorn Tags: Correspondence Source Type: research

Comment Preventive antibiotic therapy in stroke: PASSed away?
Stroke not only impairs neurological function but also leads to severe medical complications,1 of which infections, especially pneumonia, are the most important.2 In the past 10 years, epidemiological data have consistently shown that post-stroke infections are associated with increased mortality and poor neurological outcomes.3–5 Dysphagia and a stroke-induced immunodepressive state are risk factors for post-stroke infections.6 Despite general measures for infection prevention, pneumonia remains a common and severe clinical challenge, even for patients treated in specialised stroke units5,7 that are known to reduce the ...
Source: LANCET - January 20, 2015 Category: Journals (General) Authors: Andreas Meisel Tags: Comment Source Type: research