The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke

Profilaxi antibiòtica; Infeccions; Pneumònia

Detalles Bibliográficos
Autores: Ulm, Lena, Hoffmann, Sarah, Nabavi, Darius, Hermans, Marcella, Mackert, Bruno-Marcel, Hamilton, Frank, Montaner Villalonga, Joan, Bustamante Rangel, Alejandro
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Departament de Salut de la Generalitat de Catalunya (DS)
Repositorio:Scientia. Dipòsit d'Informació Digital del Departament de Salut
OAI Identifier:oai:scientiasalut.gencat.cat:11351/5928
Acceso en línea:https://hdl.handle.net/11351/5928
Access Level:acceso abierto
Palabra clave:Pneumònia
Medicaments - Administració
Infart de miocardi
DISEASES::Respiratory Tract Diseases::Lung Diseases::Pneumonia
Other subheadings::Other subheadings::Other subheadings::/drug therapy
DISEASES::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Myocardial Infarction
ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::neumonía
Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia
ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::isquemia miocárdica::infarto de miocardio
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network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
title The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
spellingShingle The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
Ulm, Lena
Pneumònia
Medicaments - Administració
Infart de miocardi
DISEASES::Respiratory Tract Diseases::Lung Diseases::Pneumonia
Other subheadings::Other subheadings::Other subheadings::/drug therapy
DISEASES::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Myocardial Infarction
ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::neumonía
Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia
ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::isquemia miocárdica::infarto de miocardio
title_short The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
title_full The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
title_fullStr The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
title_full_unstemmed The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
title_sort The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after Stroke
dc.creator.none.fl_str_mv Ulm, Lena
Hoffmann, Sarah
Nabavi, Darius
Hermans, Marcella
Mackert, Bruno-Marcel
Hamilton, Frank
Montaner Villalonga, Joan
Bustamante Rangel, Alejandro
author Ulm, Lena
author_facet Ulm, Lena
Hoffmann, Sarah
Nabavi, Darius
Hermans, Marcella
Mackert, Bruno-Marcel
Hamilton, Frank
Montaner Villalonga, Joan
Bustamante Rangel, Alejandro
author_role author
author2 Hoffmann, Sarah
Nabavi, Darius
Hermans, Marcella
Mackert, Bruno-Marcel
Hamilton, Frank
Montaner Villalonga, Joan
Bustamante Rangel, Alejandro
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Institut Català de la Salut
[Ulm L] NeuroCure Clinical Research Center, Charité – Universitaetsmedizin Berlin, Berlin, Germany. Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia. Department of Neurology and Center for Stroke Research Berlin, Charité – Universitaetsmedizin Berlin, Berlin, Germany. [Hoffmann S] NeuroCure Clinical Research Center, Charité – Universitaetsmedizin Berlin, Berlin, Germany. Department of Neurology and Center for Stroke Research Berlin, Charité – Universitaetsmedizin Berlin, Berlin, Germany. [Nabavi D, Hermans M] Department of Neurology, Vivantes Klinikum Neukoelln, Berlin, Germany. [Mackert BM, Hamilton F] Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany. [Montaner J, Bustamante A] Grup Malalties neurovasculars, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain
Vall d'Hebron Barcelona Hospital Campus
dc.subject.none.fl_str_mv Pneumònia
Medicaments - Administració
Infart de miocardi
DISEASES::Respiratory Tract Diseases::Lung Diseases::Pneumonia
Other subheadings::Other subheadings::Other subheadings::/drug therapy
DISEASES::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Myocardial Infarction
ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::neumonía
Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia
ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::isquemia miocárdica::infarto de miocardio
topic Pneumònia
Medicaments - Administració
Infart de miocardi
DISEASES::Respiratory Tract Diseases::Lung Diseases::Pneumonia
Other subheadings::Other subheadings::Other subheadings::/drug therapy
DISEASES::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Myocardial Infarction
ENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::neumonía
Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia
ENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::isquemia miocárdica::infarto de miocardio
description Profilaxi antibiòtica; Infeccions; Pneumònia
publishDate 2017
dc.date.none.fl_str_mv 2017
2021
2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11351/5928
url https://hdl.handle.net/11351/5928
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Frontiers in Neurology;8
http://journal.frontiersin.org/article/10.3389/fneur.2017.00153/full
info:eu-repo/grantAgreement/EC/FP7/201024
info:eu-repo/grantAgreement/EC/FP7/202213
dc.rights.none.fl_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Frontiers Media
publisher.none.fl_str_mv Frontiers Media
dc.source.none.fl_str_mv Scientia
reponame:Scientia. Dipòsit d'Informació Digital del Departament de Salut
instname:Departament de Salut de la Generalitat de Catalunya (DS)
instname_str Departament de Salut de la Generalitat de Catalunya (DS)
reponame_str Scientia. Dipòsit d'Informació Digital del Departament de Salut
collection Scientia. Dipòsit d'Informació Digital del Departament de Salut
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869405258964271104
spelling The Randomized Controlled STRAWINSKI Trial: Procalcitonin-Guided Antibiotic Therapy after StrokeUlm, LenaHoffmann, SarahNabavi, DariusHermans, MarcellaMackert, Bruno-MarcelHamilton, FrankMontaner Villalonga, JoanBustamante Rangel, AlejandroPneumòniaMedicaments - AdministracióInfart de miocardiDISEASES::Respiratory Tract Diseases::Lung Diseases::PneumoniaOther subheadings::Other subheadings::Other subheadings::/drug therapyDISEASES::Cardiovascular Diseases::Heart Diseases::Myocardial Ischemia::Myocardial InfarctionENFERMEDADES::enfermedades respiratorias::enfermedades pulmonares::neumoníaOtros calificadores::Otros calificadores::Otros calificadores::/farmacoterapiaENFERMEDADES::enfermedades cardiovasculares::enfermedades cardíacas::isquemia miocárdica::infarto de miocardioProfilaxi antibiòtica; Infeccions; PneumòniaProfilaxis antibiótica; Infecciones; NeumoníaAntibiotic prophylaxis; Infections; PneumoniaBackground: 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.This trial was supported by the European Union (FP7/2008-2013; 201024 and 202213), the German Ministry for Health and Education (01EO0801), the German Research Foundation (Exc257, SFB-TRR84, UL423/1-1), and Thermo Fisher Scientific BRAHMS GmbH, Germany.Frontiers MediaInstitut Català de la Salut[Ulm L] NeuroCure Clinical Research Center, Charité – Universitaetsmedizin Berlin, Berlin, Germany. Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia. Department of Neurology and Center for Stroke Research Berlin, Charité – Universitaetsmedizin Berlin, Berlin, Germany. [Hoffmann S] NeuroCure Clinical Research Center, Charité – Universitaetsmedizin Berlin, Berlin, Germany. Department of Neurology and Center for Stroke Research Berlin, Charité – Universitaetsmedizin Berlin, Berlin, Germany. [Nabavi D, Hermans M] Department of Neurology, Vivantes Klinikum Neukoelln, Berlin, Germany. [Mackert BM, Hamilton F] Department of Neurology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany. [Montaner J, Bustamante A] Grup Malalties neurovasculars, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, SpainVall d'Hebron Barcelona Hospital Campus202120212017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/11351/5928Scientiareponame:Scientia. Dipòsit d'Informació Digital del Departament de Salutinstname:Departament de Salut de la Generalitat de Catalunya (DS)InglésFrontiers in Neurology;8http://journal.frontiersin.org/article/10.3389/fneur.2017.00153/fullinfo:eu-repo/grantAgreement/EC/FP7/201024info:eu-repo/grantAgreement/EC/FP7/202213Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:scientiasalut.gencat.cat:11351/59282026-06-12T09:38:37Z
score 15,811543

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