title: Efficacy of single-dose antibiotic against early-onset pneumonia in comatose patients who are ventilated.
abstract: BACKGROUND
  Comatose patients present a high risk of early-onset ventilator-associated pneumonia (EO-VAP) for which antibiotic prophylaxis has been proposed. Comatose patients were studied to evaluate the efficacy of a single-dose of antibiotic prophylaxis at intubation against EO-VAP.
  
  
  METHODS
  A prospective cohort of comatose patients (Glasgow Coma Score ≤ 8) who were admitted in 2009-2010 and administered a single-dose of antibiotic within 4 h of intubation was compared with comatose patients (admitted ≥ 4 h after intubation in 2009-2010 or admitted in 2007-2008) who did not receive antibiotic prophylaxis. We analyzed the incidence of EO-VAP, late-onset VAP, and ventilator-associated tracheobronchitis in both groups. Propensity scores for receiving antibiotic prophylaxis were derived on the basis of patients' characteristics (eg, age and severity) to assess its impact on EO-VAP development.
  
  
  RESULTS
  We included 129 patients (71 in the prophylaxis group and 58 in the control group). The global incidence of VAP and incidence of EO-VAP were lower in the prophylaxis group: 10.8 vs 28.4 episodes/1,000 days on mechanical ventilation (P = .015) and 4.4 vs 23.1 episodes/1,000 days on mechanical ventilation (P = .02), respectively. The incidence of late-onset VAP did not differ. The prophylaxis group tended toward lower incidence of ventilator-associated tracheobronchitis (15.5% vs 25.9%, P = .14). No differences in mortality were found between groups. The propensity-score regression analysis confirmed that a single dose of antibiotic prophylaxis was independently associated with lower incidence of EO-VAP (OR, 0.11; 95% CI, 0.02-0.58; P = .009).
  
  
  CONCLUSIONS
  A single dose of antibiotic prophylaxis at intubation might lower the incidence of EO-VAP. However, a randomized clinical trial should be conducted to confirm our findings.
authors.affiliation: Critical Care Center, Hospital Sabadell, Consorci Hospitalari Universitari Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Spain. Electronic address: jvalles@tauli.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vallés
authors.affiliation: Critical Care Center, Hospital Sabadell, Consorci Hospitalari Universitari Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Peredo
authors.affiliation: Critical Care Center, Hospital Sabadell, Consorci Hospitalari Universitari Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Spain.
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Burgueño
authors.affiliation: Emergency Medicine Service, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
authors.forename: A Patrícia
authors.initials: AP
authors.lastname: Rodrigues de Freitas
authors.affiliation: Critical Care Center, Hospital Sabadell, Consorci Hospitalari Universitari Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Millán
authors.affiliation: Microbiology Laboratory, UDIAT, Consorci Hospitalari Universitari Parc Taulí, Sabadell, Spain.
authors.forename: Mateu
authors.initials: M
authors.lastname: Espasa
authors.affiliation: Critical Care Center, Hospital Sabadell, Consorci Hospitalari Universitari Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martín-Loeches
authors.affiliation: Critical Care Center, Hospital Sabadell, Consorci Hospitalari Universitari Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: Epidemiology and Assessment Unit, Fundació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Suarez
authors.affiliation: Critical Care Center, Hospital Sabadell, Consorci Hospitalari Universitari Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D003128:Coma / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents