***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Fever after stroke is a strong predictor for a negative outcome with infections as the most common cause . The aim of this pilot study was to evaluate the effects of prophylactic antibiotic therapy on the incidence and height of fever after acute ischemic stroke . Methods — This is a r and omized , controlled study of antibiotic prophylaxis in patients with ischemic stroke enrolled within 24 hours from clinical onset who presented bedridden ( modified Rankin score > 3 ) with no significant infection . Interventions included prophylactic mezlocillin plus sulbactam ( 3 × 2 g/1 g for 4 days ) or conventional management . Over 10 days , body temperature was continuously monitored , and the presence of infection was daily assessed . Primary end points were incidence and height of fever ; secondary end points included rate of infection and clinical outcome . Results — Sixty patients were included ( mean , 75 years ; median National Institutes of Health Stroke Scale score , 16 ) . Over the first 3 days , patients in the intervention group showed lower mean body temperatures as well as lower daily peak temperatures ( P<0.05 ) . Throughout the observation period , 15 of 30 patients in the intervention group but 27 of 30 patients in the conventionally treated group developed an infection ( P<0.05 ) . Mean interval until the diagnosis of infection was 5.1 days in the intervention group and 3.3 days in the control group ( P<0.05 ) . Clinical outcome was more favorable in patients with prophylactic therapy ( P=0.01 ) . Conclusions — In patients with acute severe stroke , prophylactic administration of mezlocillin plus sulbactam over 4 days decreases body temperature , lowers the rate of infection , and may be associated with a better clinical outcome BACKGROUND AND PURPOSE This prospect i ve , multicenter study was performed to determine the frequency of symptomatic complications up to 30 months after stroke using prespecified definitions of complications . METHODS We recruited 311 consecutive stroke patients admitted to hospital . Research nurses review ed their progress on a weekly basis until hospital discharge and again at 6 , 18 , and 30 months after stroke . RESULTS Complications during hospital admission were recorded in 265 ( 85 % ) of stroke patients . Specific complications were as follows : neurological-recurrent stroke ( 9 % of patients ) , epileptic seizure ( 3 % ) ; infections-urinary tract infection ( 24 % ) , chest infection ( 22 % ) , others ( 19 % ) ; mobility related-falls ( 25 % ) , falls with serious injury ( 5 % ) , pressure sores ( 21 % ) ; thromboembolism-deep venous thrombosis ( 2 % ) , pulmonary embolism ( 1 % ) ; pain-shoulder pain ( 9 % ) , other pain ( 34 % ) ; and psychological-depression ( 16 % ) , anxiety ( 14 % ) , emotionalism ( 12 % ) , and confusion ( 56 % ) . During follow-up , infections , falls , " blackouts , " pain , and symptoms of depression and anxiety remained common . Complications were observed across all 3 hospital sites , and their frequency was related to patient dependency and duration after stroke . CONCLUSIONS Our prospect i ve cohort study has confirmed that poststroke complications , particularly infections and falls , are common . However , we have also identified complications relating to pain and cognitive or affective symptoms that are potentially preventable and may previously have been underestimated Background and Purpose — Pneumonia has been estimated to occur in about one third of patients after acute stroke . Only limited data are available on stroke-associated pneumonia ( SAP ) in specialized neurological intensive care units ( NICUs ) . Methods — We enrolled 124 patients with acute stroke who were treated at our university hospital NICU in a prospect i ve observational study . Incidence rates and risk factors of SAP and long-term clinical outcome were determined . Results — SAP incidence was 21 % with a spectrum of pathogens , which is comparable to previously published data on general ICU patients . Mechanical ventilation , multiple location , and vertebrobasilar stroke , as well as dysphagia and abnormal chest x-ray findings , were identified as risk factors for the disease . SAP patients showed higher mortality rates than nondiseased subjects ( acute , 26.9 % versus 8.2 % ; long-term , 35.3 % versus 14.3 % ) and a significantly poorer long-term clinical outcome ( Barthel Index , 50.5±42.4 versus 81.5±27.8 ; Rankin Scale , 3.5±1.7 versus 2.2±1.6 ) . Conclusions — Our data underline the considerable epidemiological and prognostic impact of SAP for the treatment of acute stroke patients in a specialized NICU setting . They demonstrate that the occurrence of SAP deteriorates clinical outcome in these patients . Our results allow us to identify high-risk stroke patients at time of NICU admission in whom the use of preventive treatment strategies is most promising BACKGROUND Urinary tract infection ( UTI ) is a recognized complication of stroke . We aim ed to determine the incidence of UTI after acute stroke , the risk factors associated with this complication , and its association with outcome . METHODS Prospect i ve study of consecutive acute stroke patients admitted to an urban teaching hospital . Routine clinical assessment included the modified National Institutes of Health Stroke Scale ( mNIHSS ) and modified Rankin scale ( mRS ) . Patients were followed up for 3 months , including recording of clinician diagnosis of UTI . RESULTS We studied 412 patients ; 65 ( 15.8 % ) were diagnosed with UTI , at a median of 14 days ( IQR = 4 - 39 ) post-stroke . In a binomial multivariate regression analysis , UTI was associated with urinary catheterization ( OR = 3.03 , 95 % CI 1.41 - 6.52 ) , higher mRS ( OR = 1.85 , 1.29 - 2.64 ) and increasing age ( OR = 1.51 , 1.13 - 2.00 for each decade ) . UTI was associated with death or disability at 3 months , however , this link was attenuated and became non-significant when measures of stroke severity and pre-stroke morbidity were included in a multivariate analysis . CONCLUSION UTI is common after acute stroke . It is associated with urinary catheterization , post-stroke disability and increasing age . Avoidance of catheterization might reduce the incidence of this common complication Objectives To provide information on the frequency and reasons for outcome reporting bias in clinical trials . Design Trial protocol s were compared with subsequent publication(s ) to identify any discrepancies in the outcomes reported , and telephone interviews were conducted with the respective trialists to investigate more extensively the reporting of the research and the issue of unreported outcomes . Participants Chief investigators , or lead or co authors of trials , were identified from two sources : trials published since 2002 covered in Cochrane systematic review s where at least one trial analysed was suspected of being at risk of outcome reporting bias ( issue 4 , 2006 ; issue 1 , 2007 , and issue 2 , 2007 of the Cochrane library ) ; and a r and om sample of trial reports indexed on PubMed between August 2007 and July 2008 . Setting Australia , Canada , Germany , the Netherl and s , New Zeal and , the United Kingdom , and the United States . Main outcome measures Frequency of incomplete outcome reporting — signified by outcomes that were specified in a trial ’s protocol but not fully reported in subsequent publications— and trialists ’ reasons for incomplete reporting of outcomes . Results 268 trials were identified for inclusion ( 183 from the cohort of Cochrane systematic review s and 85 from PubMed ) . Initially , 161 respective investigators responded to our requests for interview , 130 ( 81 % ) of whom agreed to be interviewed . However , failure to achieve subsequent contact , obtain a copy of the study protocol , or both meant that final interviews were conducted with 59 ( 37 % ) of the 161 trialists . Sixteen trial investigators failed to report analysed outcomes at the time of the primary publication , 17 trialists collected outcome data that were subsequently not analysed , and five trialists did not measure a prespecified outcome over the course of the trial . In almost all trials in which prespecified outcomes had been analysed but not reported ( 15/16 , 94 % ) , this under-reporting result ed in bias . In nearly a quarter of trials in which prespecified outcomes had been measured but not analysed ( 4/17 , 24 % ) , the “ direction ” of the main findings influenced the investigators ’ decision not to analyse the remaining data collected . In 14 ( 67 % ) of the 21 r and omly selected PubMed trials , there was at least one unreported efficacy or harm outcome . More than a quarter ( 6/21 , 29 % ) of these trials were found to have displayed outcome reporting bias . Conclusion The prevalence of incomplete outcome reporting is high . Trialists seemed generally unaware of the implication s for the evidence base of not reporting all outcomes and protocol changes . A general lack of consensus regarding the choice of outcomes in particular clinical setting s was evident and affects trial design , conduct , analysis , and reporting Background : We have recently shown that ischemic stroke causes a stress-mediator-induced long-lasting immunodepressive state in mice . Methods : Using head magnetic resonance imaging and st and ardized immunoassays , we prospect ively investigated whether poststroke immunodepression is also seen in humans . Results : Compared to healthy volunteers ( n = 30 ) , a rapid depression of lymphocyte counts and a functional deactivation of monocytes and T helper type 1 cells was observed in acute stroke patients ( SP ; n = 40 ) . Immunodepression was more pronounced in patients with severe clinical deficit or large infa rct ion . On admission the combination of monocytic tumor necrosis factor α release ex vivo and the National Institute of Health Stroke Scale score were the best predictors for nosocomial infection , preferentially affecting older SP . Conclusion : Our data provide evidence for an immediate suppression of cell-mediated immune responses after ischemic stroke in humans Objective To determine the incidence rates of hospital acquired infections ( HAI ) during the first 14 days after ICU discharge after treatment during ICU-stay with Selective Decontamination of the Digestive tract ( SDD ) , Selective Oropharyngeal Decontamination ( SOD ) or St and ard Care ( SC ) . Design Prospect i ve observational study . Setting ICUs in two tertiary care hospitals . Patients Patients discharged from the ICU to the ward . Interventions None . Measurements and results Post-ICU incidences of HAI per 1,000 days at risk were 11.2 , 12.9 and 8.3 for patients that had received SDD ( n = 296 ) , SOD ( n = 286 ) or SC ( n = 289 ) respectively in ICU , yielding relative risks , as compared to SC , of 1.49 ( CI95 0.9–2.47 ) for SOD and 1.44 ( CI95 0.87–2.39 ) for SDD .  Incidences of surgical site infections ( per 100 surgical procedures ) were 4 after SC and 11.8 and 8 after SOD and SDD ( p = 0.04 ) . Among patients that succumbed in the hospital after ICU-stay ( n = 58 ) eight ( 14 % ) had developed HAI after ICU discharge ; 3 of 21 after SDD , 3 of 15 after SOD and 2 of 22 after SC . Conclusions Incidences of HAI in general wards tended to be higher in patients that had received either SDD or SOD during ICU-stay , but it seems unlikely that these infections have an effect on hospital mortality rates Background Pneumonia is a major risk factor of death after acute stroke . In a mouse model , preventive antibacterial therapy with moxifloxacin not only prevents the development of post-stroke infections , it also reduces mortality , and improves neurological outcome significantly . In this study we investigate whether this approach is effective in stroke patients . Methods Preventive ANtibacterial THERapy in acute Ischemic Stroke ( PANTHERIS ) is a r and omized , double-blind , placebo-controlled trial in 80 patients with severe , non-lacunar , ischemic stroke ( NIHSS>11 ) in the middle cerebral artery ( MCA ) territory . Patients received either intravenous moxifloxacin ( 400 mg daily ) or placebo for 5 days starting within 36 hours after stroke onset . Primary endpoint was infection within 11 days . Secondary endpoints included neurological outcome , survival , development of stroke-induced immunodepression , and induction of bacterial resistance . Findings On intention-to treat analysis ( 79 patients ) , the infection rate at day 11 in the moxifloxacin treated group was 15.4 % compared to 32.5 % in the placebo treated group ( p = 0.114 ) . On per protocol analysis ( n = 66 ) , moxifloxacin significantly reduced infection rate from 41.9 % to 17.1 % ( p = 0.032 ) . Stroke associated infections were associated with a lower survival rate . In this study , neurological outcome and survival were not significantly influenced by treatment with moxifloxacin . Frequency of fluoroquinolone resistance in both treatment groups did not differ . On logistic regression analysis , treatment arm as well as the interaction between treatment arm and monocytic HLA-DR expression ( a marker for 
    Output:
    
In the previous version of this Cochrane Review , published in 2012 , we found that antibiotics did reduce the risk of infection but did not reduce the number of dependent or deceased patients .
AUTHORS ' CONCLUSIONS Preventive antibiotics had no effect on functional outcome or mortality , but significantly reduced the risk of ' overall ' infections .
This reduction was driven mainly by prevention of urinary tract infection ; no effect for pneumonia was found