Work package 3: Infections and Antimicrobial Resistance
Leader: Prof. Diederik van de Beek, Academic Medical Center Amsterdam
To assess the types and frequencies of infections in all included patients and to compare the prevalence of resistant bacteriae between patients allocated to treatment with antibiotics and patients without antibiotics.
This can be split into four component objectives:
- To assess the number of patients with infection and the type of these infections;
- To assess the total use of antibiotics;
- To asses monitor the occurrence of overgrowth of specific bacteria in the gut due to antibiotic use;
- To monitor antibiotic resistance in stool samples of patients with stroke.
Description of the tasks
One of the treatments under investigation in PRECIOUS is the antibiotic ceftriaxone to prevent infections after stroke. The AMC is a key leader in neurological infections, including infections complicating stroke.
The team at AMC will assess the total number of patients diagnosed with one or more infection(s) during hospital admission, as well as the total number of infections. Infection will be assessed in two ways. Firstly, infection will be diagnosed in the hospital as judged by the treating physician. Secondly, infections will be diagnosed according to strict international criteria by an expert panel at the AMC. Infection rates will be compared between patients who receive the antibiotic ceftriaxone and the patients who don’t. In addition, use of antibiotics other than the antibiotic therapy in PRECIOUS will be recorded by the local investigator.
A potential risk of using antibiotics on a large scale is the development of antibiotic resistance. In a large subgroup of the study, we will – after specific informed consent – collect two rectal swabs at baseline and on day 7 of hospital admission (or at discharge, if earlier). Rectal swabs will be shipped to the AMC. In the AMC, information of the bacteria in the gut will be collected and stored. This way, we are able to compare the resistance rate of bacteria between patients who receive ceftriaxone and patients without antibiotic treatment.
In addition to the risk of the development of bacterial resistance, treatment with antibiotics could lead to overgrowth of bacteria which are not killed by the antibiotic treatment. An example is the overgrowth of the bacteria Clostridium Difficile, which can cause diarrhea. Overgrowth of Clostridium Difficile will be diagnosed by the treating physician by means of analysis of stool samples. The diagnosis will be reviewed by the expert panel at AMC. In precious studies, only a few (<1%) patients developed overgrowth of this bacteria. The occurrence of Clostridium Difficile overgrowth will be compared between patients treated with ceftriaxone and those in the control group.