Lower respiratory tract infections following cardiac arrest and cardiopulmonary resuscitation.
All episodes of lower respiratory tract infection that developed among 96 patients surviving for > 24 hours after cardiac arrest were prospectively studied over an 18-month period. Pneumonia developed in 23 (24.0%) of patients after a mean of 7 days (SD, +/- 6.2 days). The development of four superinfections raised the cumulative incidence to 28.1%. Purulent tracheobronchitis was diagnosed in three instances. The causative agent of pneumonia was identified in 18 episodes, three of which were polymicrobial. Gram-positive cocci represented 57.1% of isolates, and Staphylococcus aureus--the most frequently isolated microorganism in this population--accounted for two-thirds of all gram-positive cocci. Pseudomonas aeruginosa was isolated in six episodes, five of which were associated with previous antibiotic use. Nine (39.1%) of the 23 patients in the group with pneumonia died, but only one of these deaths was considered to be directly related to pneumonia. In conclusion, pneumonia is a common complication of patients surviving cardiac arrest, but, with adequate treatment, its influence on outcome is marginal. Gram-positive cocci are the predominant pathogens, although infection with P. aeruginosa should be considered among patients receiving antibiotics.
Rello
J
J
Intensive Care Department, Hospital de Sabadell, Barcelona, Spain.
Vallés
J
J
Jubert
P
P
Ferrer
A
A
Domingo
C
C
Mariscal
D
D
Fontanals
D
D
Artigas
A
A
D001991:Bronchitis / Q000382:microbiology / Q000401:mortality; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D001999:Bronchoscopy; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D005260:Female; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000209:etiology* / Q000401:mortality; D011023:Pneumonia, Staphylococcal / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology*; D013030:Spain / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D015996:Survival Rate; D014136:Tracheitis / Q000382:microbiology / Q000401:mortality