title: Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era.
abstract: OBJECTIVE
  Infectious complications are frequently reported in critically ill patients, especially after cardiac arrest. Recent and widespread use of therapeutic hypothermia has raised concerns about increased septic complications, but no specific reappraisal has been performed. We investigated the infectious complications in cardiac arrest survivors and assessed their impact on morbidity and long-term outcome.
  
  
  METHODS
  Retrospective review of a prospectively acquired intensive care unit database.
  
  
  METHODS
  A 24-bed medical intensive care unit in a French university hospital.
  
  
  METHODS
  Between March 2004 and March 2008, consecutive patients admitted for management of resuscitated out-of-hospital cardiac arrest were considered. Patients dying within 24 hrs were excluded. All patients' files were reviewed to assess the development of infection.
  
  
  METHODS
  None.
  
  
  RESULTS
  Of the 537 patients admitted after cardiac arrest, 421 were included and 281 patients (67%) presented 373 infectious complications. Pneumonia was the most frequent (318 episodes), followed by bloodstream infections (35 episodes) and catheter-related infections (11 episodes). When grouped together, Gram-negative bacteria were the most frequently isolated infectious germs (64%), but the main pathogen detected was Staphylococcus aureus (57 occurrences). Both application itself (83 vs. 73%; p = .02) and duration (1244 vs. 1176 mins; p = .05) of therapeutic hypothermia were significantly more frequent in infected patients. Infection was associated with increased mechanical ventilation duration (6 [2-9] vs. 3 [2-5.5] days; p < .001) and intensive care unit length of stay (7 [4-10] vs. 3 [2-7] days; p < .001). Nonetheless, there was no impact on intensive care unit mortality (174 [62%] vs. 92 [66%] patients; p = .45) or on favorable neurologic outcome (cerebral performance category 1-2, 102 [36%] vs. 47 [34%] patients; p = .58).
  
  
  CONCLUSIONS
  Infectious complications are frequent after cardiac arrest and may be even more frequent after therapeutic hypothermia. Despite increase in care costs, long-term and clinically relevant outcomes do not seem to be impaired. This should not discourage the use of therapeutic hypothermia in cardiac arrest survivors.
authors.affiliation: Medical Intensive Care Unit, AP-HP, Cochin Hospital, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mongardon
authors.forename: Sébastien
authors.initials: S
authors.lastname: Perbet
authors.forename: Virginie
authors.initials: V
authors.lastname: Lemiale
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.forename: Hélène
authors.initials: H
authors.lastname: Poupet
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Péne
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D015994:Incidence; D007239:Infections / Q000453:epidemiology* / Q000382:microbiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D012151:Resuscitation; D012189:Retrospective Studies