David J Gagnon1, Niklas Nielsen2, Gilles L Fraser3, Richard R Riker4, John Dziodzio5, Kjetil Sunde6, Jan Hovdenes7, Pascal Stammet8, Hans Friberg9, Sten Rubertsson10, Michael Wanscher11, David B Seder4. 1. Department of Pharmacy, Maine Medical Center, Portland, ME, USA. Electronic address: dgagnon@mmc.org. 2. Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden. 3. Department of Pharmacy, Maine Medical Center, Portland, ME, USA; Department of Critical Care Services, Maine Medical Center, Portland, ME, USA. 4. Department of Critical Care Services, Maine Medical Center, Portland, ME, USA; Neuroscience Institute, Maine Medical Center, Portland, ME, USA; Division of Pulmonary Medicine, Maine Medical Center, Portland, ME, USA. 5. Department of Critical Care Services, Maine Medical Center, Portland, ME, USA. 6. Oslo University Hospital Ulleval, Department of Anesthesiology, Division of Emergencies and Critical Care, Norway. 7. Oslo University Hospital Rikshospitalet, Department of Anesthesiology, Division of Emergencies and Critical Care, Norway. 8. Department of Anesthesia and Intensive Care, Centre de Hospitalier de Luxembourg, Luxembourg. 9. Department of Clinical Sciences, Lund University, Lund, Sweden. 10. Department of Anesthesiology and Intensive Care, Uppsala University, Uppsala Sweden. 11. Department of Cardiothoracic Anesthesia, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
Abstract
INTRODUCTION:Prophylactic antibiotics (PRO) reduce the incidence of early-onset pneumonia in comatose patients with structural brain injury, but have not been examined in cardiac arrest survivors undergoing targeted temperature management (TTM). We investigated the effect of PRO on the development of pneumonia in that population. METHODS: We conducted a retrospective cohort study comparing patients treated with PRO to those not receiving PRO (no-PRO) using Northern Hypothermia Network registry data. Cardiac arrest survivors ≥ 18 years of age with a GCS<8 at hospital admission and treated with TTM at 32-34 °C were enrolled in the registry. Differences were analyzed in univariate analyses and with logistic regression models to evaluate independent associations of clinical factors with incidence of pneumonia and good functional outcome. RESULTS: 416 of 1240 patients (33.5%) receivedPRO. Groups were similar in age, gender, arrest location, initial rhythm, and time from collapse to return of spontaneous circulation. PRO patients had less pneumonia (12.6% vs. 54.9%, p < 0.001) and less sepsis (1.2 vs. 5.7%, p < 0.001) compared to no-PRO patients. ICU length of stay (98 vs. 100 h, p = 0.2) and incidence of a good functional outcome (41.1 vs. 36.6%, p = 0.19) were similar between groups. Backwards stepwise logistic regression demonstrated PRO were independently associated with a lower incidence of pneumonia (OR 0.09, 95% 0.06-0.14, p < 0.001) and a similar incidence of good functional outcome. CONCLUSIONS:Prophylactic antibiotics were associated with a reduced incidence of pneumonia but a similar rate of good functional outcome.
RCT Entities:
INTRODUCTION: Prophylactic antibiotics (PRO) reduce the incidence of early-onset pneumonia in comatosepatients with structural brain injury, but have not been examined in cardiac arrest survivors undergoing targeted temperature management (TTM). We investigated the effect of PRO on the development of pneumonia in that population. METHODS: We conducted a retrospective cohort study comparing patients treated with PRO to those not receiving PRO (no-PRO) using Northern Hypothermia Network registry data. Cardiac arrest survivors ≥ 18 years of age with a GCS<8 at hospital admission and treated with TTM at 32-34 °C were enrolled in the registry. Differences were analyzed in univariate analyses and with logistic regression models to evaluate independent associations of clinical factors with incidence of pneumonia and good functional outcome. RESULTS: 416 of 1240 patients (33.5%) received PRO. Groups were similar in age, gender, arrest location, initial rhythm, and time from collapse to return of spontaneous circulation. PROpatients had less pneumonia (12.6% vs. 54.9%, p < 0.001) and less sepsis (1.2 vs. 5.7%, p < 0.001) compared to no-PROpatients. ICU length of stay (98 vs. 100 h, p = 0.2) and incidence of a good functional outcome (41.1 vs. 36.6%, p = 0.19) were similar between groups. Backwards stepwise logistic regression demonstrated PRO were independently associated with a lower incidence of pneumonia (OR 0.09, 95% 0.06-0.14, p < 0.001) and a similar incidence of good functional outcome. CONCLUSIONS: Prophylactic antibiotics were associated with a reduced incidence of pneumonia but a similar rate of good functional outcome.
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