Pre-antibiotic use tied to higher risk of secondary stroke after acute ischemic and hemorrhagic stroke: Study

"In a study involving over 200,000 adults aged 55 and older with acute hemorrhagic stroke (AHS) or acute ischemic stroke (AIS), pre-antibiotic use within a year before the stroke event was linked to increased risks of secondary stroke in both groups (aHR of 1.03 for AIS and 1.08 for AHS)," the researchers reported in the International Journal of General Medicine. However, pre-antibiotic use in the AIS group was tied to a reduced mortality risk (aHR 0.95).

Dougho Park, Medical Research Institute, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea, and colleagues conducted the study to investigate the effects of pre-antibiotic use before a stroke event on secondary outcomes using a longitudinal population-level database.

For this purpose, the researchers conducted a retrospective cohort study comprising adults aged 55 years or older diagnosed with acute hemorrhagic stroke and acute ischemic stroke between 2004 and 2007. Patients were followed up until the end of 2019, and the target outcomes included secondary AIS, AHS, and all-cause mortality.

Multivariable Cox regression analyses were applied, and the researchers adjusted covariates such as sex, age, socioeconomic status, hypertension, dyslipidemia, and diabetes. Pre-antibiotic use was identified from 7 days to 1 year before the acute stroke event.

The study led to the following findings:

• 159,181 patients with AIS (AIS group) and 49,077 patients with AHS (AHS group) were included.
• Pre-antibiotic use significantly increased the risk of secondary AIS in the AIS group (adjusted hazard ratio [aHR], 1.03) and secondary AHS in the AHS group (aHR, 1.08).
• Furthermore, pre-antibiotic use in the AIS group was associated with a lower risk of mortality (aHR, 0.95).

This study elucidated the effect of pre-antibiotic use during a specific period before the first incidence of stroke on long-term secondary outcomes. As an observational, longitudinal study using a population-level database, the study confirmed that pre-antibiotic use was significantly associated with the risk of secondary stroke.

"Our population-based longitudinal study showed that pre-antibiotic use was associated with a higher risk of secondary stroke and a lower risk of mortality in the AIS and AHS groups," the researchers wrote. "There is a need for further studies to understand the relationship between dysbiosis and stroke outcomes."

Reference:

Park D, Kim HS, Kim JH. Effect of Pre-Antibiotic Use Before First Stroke Incidence on Recurrence and Mortality: A Longitudinal Study Using the Korean National Health Insurance Service Database. Int J Gen Med. 2024;17:1625-1633

https://doi.org/10.2147/IJGM.S456925