Prophylactic antibiotics decrease ventilator-associated pneumonia risk after cardiac arrest
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A 2-day course of prophylactic antibiotic therapy lowered the incidence of early ventilator-associated pneumonia among patients treated with target temperature management after out-of-hospital cardiac arrest, according to results from the ANTHARTIC trial.
The randomized, double-blind, placebo-controlled trial enrolled adults who were hospitalized at 16 ICUs in France after an out-of-hospital cardiac arrest with shockable rhythm and who were treated with 32°C to 34°C targeted temperature management. Within 6 hours after the return of spontaneous circulation, patients were randomly assigned antibiotic therapy with amoxicillin-clavulanate injections three times daily to prevent early ventilator-associated pneumonia or saline injections for 2 days.
A total of 194 patients were included in the analysis.
Sixty cases of ventilator-associated pneumonia were confirmed by an adjudication committee, including 51 cases of early ventilator-associated pneumonia, which was defined as occurring during the first 7 days of hospitalization.
Results showed that patients treated with prophylactic antibiotics, as compared with placebo, had a significantly lower incidence of early ventilator-associated pneumonia (19% vs. 34%; HR = 0.53; 95% CI, 0.31-0.92). There was no difference, however, in the incidence of late ventilator-associated pneumonia, but this finding was consistent with data from previous studies, the researchers noted.
Treatment with prophylactic antibiotics vs. placebo also appeared to have no significant effect on the median number of ventilator-free days (21 vs. 19 days); median ICU length of stay, regardless of whether patients were discharged (5 vs. 8 days) or whether they died (7 vs. 7 days); and death at 28 days (41% vs. 37%). Additionally, results from rectal swabbing before and after the 2-day course of prophylactic antibiotics were not associated with an increase in resistant bacteria at 7 days.
Incidence of serious adverse events did not differ significantly between groups, with 55 events occurring among 48 patients in the treatment arm and 52 events occurring among 42 patients in the placebo arm, and none were considered related to treatment.
“In patients treated with targeted temperature management after resuscitation of out-of-hospital cardiac arrests with shockable rhythm, we found that a 2-day treatment with amoxicillin-clavulanate resulted in a lower incidence of early ventilator-associated pneumonia than placebo,” the researchers wrote.
However, they noted that the study had several limitations, including the inability to generalize the results to patients with in-hospital cardiac arrest, out-of-hospital cardiac arrest with nonshockable rhythm or out-of-hospital cardiac arrest that was managed with a different targeted temperature. Further, patients with overt aspiration were excluded from the trial and microbiota analysis for detection of multidrug-resistant bacteria was not repeated after 7 days. – by Melissa Foster
Disclosures: François reports he has received grants from the French Ministry of Health (PHRC program) and personal fees from AM-Pharma, Aridis, Ashai-Kasai, Biomérieux, Ferring and Inotrem.