Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest—A randomized pilot study

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• 作者：Suada Filekovic Ribaric^a ; Matjaz Turel^b ; Rihard Knafelj^c ; Vojka Gorjup^c ; Rade Stanic^a ; Primoz Gradisek^a ; Ognjen Cerovic^a ; Tomislav Mirkovic^a ; Marko Noc^c ; ^{marko.noc@mf.uni-lj.si}
• 关键词：Out-of-hospital cardiac arrest ; Prophylactic antibiotic treatment ; Hypothermia
• 刊名：Resuscitation
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：111
• 期：Complete
• 页码：103-109
• 全文大小：911 K
• 卷排序：111

文摘

To investigate benefits of prophylactic antibiotics in comatose survivors of out-of-hospital cardiac arrest (OHCA).MethodsPatients without evidence of tracheobronchial aspiration on admission bronchoscopy were randomized to prophylactic Amoxicillin–Clavulanic acid 1.2 g every 8 h (P) or clinically-driven antibiotics (C) administered if signs of infection developed during initial 7 days of intensive care unit (ICU) stay.ResultsAmong 83 patients enrolled between September 2013 and February 2015, tracheobronchial aspiration was documented in 23 (28%). Accordingly, 60 patients were randomized. Percentage of patients on antibiotics between days 1–5 was significantly greater in P group. White blood count, C-reactive protein, procalcitonin (PCT) and CD 64 significantly increased during the postresuscitation phase. Except for lower CRP and PCT in group P on day 6 (p < 0.05), there was no significant differences. Mini BAL on day 3 was less often positive in group P (7% vs. 42%; p < 0.01). There was no significant difference in other microbiological samples and X-ray signs of pneumonia cumulatively documented in 50% in both groups. Use of vasopressors/inotropes (93% in both groups), duration of mechanical ventilation (5.4 ± 3.7 vs. 5.2 ± 3.1 days), tracheal intubation (6.5 ± 4.6 vs. 5.9 ± 4.3 days), ICU stay (7.7 ± 5.2 vs. 6.9 ± 4.5 days), survival (73% vs. 73%) and survival with good neurological outcome (50% vs. 40%) were also comparable between P and C groups.ConclusionBronchoscopy on admission documented tracheobronchial aspiration in 28% of comatose survivors of OHCA. In the absence of aspiration, prophylactic antibiotics did not significantly alter systemic inflammatory response, postresuscitation pneumonia, ICU treatment and outcome (ClinicalTrials.gov Identifier: NCT02899507).