Florian Reizine1, Karim Asehnoune2, Antoine Roquilly3, Bruno Laviolle4, Chloé Rousseau5, Matthieu Arnouat6, Claire Dahyot-Fizelier7, Philippe Seguin8. 1. CHU Rennes, Service de Réanimation Chirurgicale, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes 35000, France. 2. Département d'Anesthésie Réanimation, CHU Nantes, 1 Place Alexis-Ricordeau, Nantes 44000, France. Electronic address: karim.asehnoune@chu-nantes.fr. 3. Département d'Anesthésie Réanimation, CHU Nantes, 1 Place Alexis-Ricordeau, Nantes 44000, France. Electronic address: antoine.roquilly@chu-nantes.fr. 4. CHU de Rennes, Centre d'Investigation Clinique, 2 rue Henri Le Guilloux, Rennes 35000, France. Electronic address: bruno.laviolle@chu-rennes.fr. 5. CHU de Rennes, Centre d'Investigation Clinique, 2 rue Henri Le Guilloux, Rennes 35000, France. Electronic address: chloe.rousseau@chu-rennes.fr. 6. CHU Rennes, Service de Réanimation Chirurgicale, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes 35000, France. Electronic address: matthieu.arnouat@chu-rennes.fr. 7. Département d'Anesthésie Réanimation, CHU Poitiers, 2 Rue de la Milétrie, Poitiers 16000, France. Electronic address: claire.dahyot-fizelier@chu-rennes.fr. 8. CHU Rennes, Service de Réanimation Chirurgicale, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes 35000, France. Electronic address: philippe.seguin@chu-rennes.fr.
Abstract
PURPOSE: To investigate the role of antibiotic prophylaxis (AP) in the incidence of ventilator-associated pneumonia (VAP) in patients suffering from traumatic brain injury (TBI). MATERIALS AND METHODS: This post hoc analysis was conducted based on data from 2 multicentre double-blind studies that aimed to prevent VAP using hydrocortisone or povidone iodine. Data from TBI patients were extracted and pooled. Patients were classified into 2 groups: those who received an AP (AP group) and those who did not (control group). RESULTS: 295 patients were included (AP group, n = 146; control group, n = 149). The incidence of VAP was 145 (49%). VAP incidence was lower in the AP group (39% vs 59%, Relative Risk = 0.33, 95%CI, 0.19-0.56, p = 0.001). Time to VAP occurrence was delayed (Hazard Ratio = 0.50, 95%CI 0.36-0.69, p < 0.001). The incidence of early VAP (>2 and ≤ 5 days) was lower in the AP group (10% vs 32%; p < 0.001), whereas that of late VAP (>5 days) did not differ (AP group 29% vs control group 28%; p = 0.811). Length of stay and mortality did not differ between the 2 groups. CONCLUSIONS: Early use of AP delayed and may prevent the occurrence of VAP in severe TBI patients but did not change length of stay or mortality.
PURPOSE: To investigate the role of antibiotic prophylaxis (AP) in the incidence of ventilator-associated pneumonia (VAP) in patients suffering from traumatic brain injury (TBI). MATERIALS AND METHODS: This post hoc analysis was conducted based on data from 2 multicentre double-blind studies that aimed to prevent VAP using hydrocortisone or povidone iodine. Data from TBIpatients were extracted and pooled. Patients were classified into 2 groups: those who received an AP (AP group) and those who did not (control group). RESULTS: 295 patients were included (AP group, n = 146; control group, n = 149). The incidence of VAP was 145 (49%). VAP incidence was lower in the AP group (39% vs 59%, Relative Risk = 0.33, 95%CI, 0.19-0.56, p = 0.001). Time to VAP occurrence was delayed (Hazard Ratio = 0.50, 95%CI 0.36-0.69, p < 0.001). The incidence of early VAP (>2 and ≤ 5 days) was lower in the AP group (10% vs 32%; p < 0.001), whereas that of late VAP (>5 days) did not differ (AP group 29% vs control group 28%; p = 0.811). Length of stay and mortality did not differ between the 2 groups. CONCLUSIONS: Early use of AP delayed and may prevent the occurrence of VAP in severe TBIpatients but did not change length of stay or mortality.