Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome

Klaudia Nowak; Justyna Derbisz; Jan Pęksa; Bartłomiej Łasocha; Paweł Brzegowy; Joanna Slowik; Paweł Wrona; Roman Pulyk; Tadeusz Popiela; Agnieszka Slowik

doi:10.5114/aic.2020.101771

Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome

Postepy Kardiol Interwencyjnej. 2020 Dec;16(4):452-459. doi: 10.5114/aic.2020.101771. Epub 2020 Dec 29.

Authors

Affiliations

¹ Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
² Department of Cardiology, Interventional Cardiology and Hypertension, University Hospital, Krakow, Poland.
³ Department of Radiology, University Hospital, Krakow, Poland.
⁴ Department of Dental Prophylaxis and Experimental Dentistry, Jagiellonian University Medical College, Krakow, Poland.

Abstract

Introduction: The impact of an infection that requires antibiotic treatment (IRAT) after an acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT) remains unclear.

Aim: Here, we studied the prevalence and the profile of IRAT in patients with AIS treated with MT, aiming to identify predictive factors and prognostic implications at 90 days after stroke.

Material and methods: We analyzed parameters available within 24 h after AIS including demographics, risk factors, National Institutes of Health Stroke Scale (NIHSS) upon admission and 24 h later, hemorrhagic transformation (HT) on computed tomography, and several clinical and biochemical markers. The outcome measures were the modified Rankin Scale (mRS) 0-2 and 90 days post-stroke mortality.

Results: We included 291 patients; in 184 (63.2%) patients MT was preceded by intravenous thrombolysis (IVT), and 83 (28.5%) patients developed IRAT. Multivariate analysis showed that male sex and hemorrhagic transformation on CT taken 24 h after stroke increased the risk of IRAT. We found that younger age, male sex, lower delta NIHSS, shorter time from stroke onset to groin puncture, better recanalization and a lack of hemorrhagic transformation on CT taken 24 h after stroke favorably affected outcome at day 90. Multivariate analysis showed that older age, higher delta NIHSS, unknown stroke etiology and lack of treatment with IVT were independent predictors of death up to day 90. Infection that required antibiotic treatment did not enter in the models for the studied outcome measures.

Conclusions: In AIS patients treated with MT, IRAT is not an independent factor that affects favorable outcome or mortality 90 days after stroke.

Keywords: acute ischemic stroke; antibiotic therapy; infections; long-term outcome; mechanical thrombectomy; mortality.