title: Prophylactic antibiotics are associated with a lower incidence of pneumonia in cardiac arrest survivors treated with targeted temperature management.
abstract: BACKGROUND
  Prophylactic antibiotics (PRO) reduce the incidence of early-onset pneumonia in comatose patients with structural brain injury, but have not been examined in cardiac arrest survivors undergoing targeted temperature management (TTM). We investigated the effect of PRO on the development of pneumonia in that population.
  
  
  METHODS
  We conducted a retrospective cohort study comparing patients treated with PRO to those not receiving PRO (no-PRO) using Northern Hypothermia Network registry data. Cardiac arrest survivors ≥ 18 years of age with a GCS<8 at hospital admission and treated with TTM at 32-34 °C were enrolled in the registry. Differences were analyzed in univariate analyses and with logistic regression models to evaluate independent associations of clinical factors with incidence of pneumonia and good functional outcome.
  
  
  RESULTS
  416 of 1240 patients (33.5%) received PRO. Groups were similar in age, gender, arrest location, initial rhythm, and time from collapse to return of spontaneous circulation. PRO patients had less pneumonia (12.6% vs. 54.9%, p < 0.001) and less sepsis (1.2 vs. 5.7%, p < 0.001) compared to no-PRO patients. ICU length of stay (98 vs. 100 h, p = 0.2) and incidence of a good functional outcome (41.1 vs. 36.6%, p = 0.19) were similar between groups. Backwards stepwise logistic regression demonstrated PRO were independently associated with a lower incidence of pneumonia (OR 0.09, 95% 0.06-0.14, p < 0.001) and a similar incidence of good functional outcome.
  
  
  CONCLUSIONS
  Prophylactic antibiotics were associated with a reduced incidence of pneumonia but a similar rate of good functional outcome.
authors: Department of Pharmacy, Maine Medical Center, Portland, ME, USA. Electronic address: dgagnon@mmc.org.
authors: David J
authors: DJ
authors: Gagnon
authors: Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
authors: Niklas
authors: N
authors: Nielsen
authors: Department of Pharmacy, Maine Medical Center, Portland, ME, USA; Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.
authors: Gilles L
authors: GL
authors: Fraser
authors: Department of Critical Care Services, Maine Medical Center, Portland, ME, USA; Neuroscience Institute, Maine Medical Center, Portland, ME, USA; Division of Pulmonary Medicine, Maine Medical Center, Portland, ME, USA.
authors: Richard R
authors: RR
authors: Riker
authors: Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.
authors: John
authors: J
authors: Dziodzio
authors: Oslo University Hospital Ulleval, Department of Anesthesiology, Division of Emergencies and Critical Care, Norway.
authors: Kjetil
authors: K
authors: Sunde
authors: Oslo University Hospital Rikshospitalet, Department of Anesthesiology, Division of Emergencies and Critical Care, Norway.
authors: Jan
authors: J
authors: Hovdenes
authors: Department of Anesthesia and Intensive Care, Centre de Hospitalier de Luxembourg, Luxembourg.
authors: Pascal
authors: P
authors: Stammet
authors: Department of Clinical Sciences, Lund University, Lund, Sweden.
authors: Hans
authors: H
authors: Friberg
authors: Department of Anesthesiology and Intensive Care, Uppsala University, Uppsala Sweden.
authors: Sten
authors: S
authors: Rubertsson
authors: Department of Cardiothoracic Anesthesia, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
authors: Michael
authors: M
authors: Wanscher
authors: Department of Critical Care Services, Maine Medical Center, Portland, ME, USA; Neuroscience Institute, Maine Medical Center, Portland, ME, USA; Division of Pulmonary Medicine, Maine Medical Center, Portland, ME, USA.
authors: David B
authors: DB
authors: Seder
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001831:Body Temperature / Q000502:physiology*; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012042:Registries; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics; Cardiac arrest; Hypothermia; Intensive care; Pneumonia; Temperature