title: Early pneumonia and timing of antibiotic therapy in patients after nontraumatic out-of-hospital cardiac arrest.
abstract: BACKGROUND
  While early pneumonia is common in patients after out-of-hospital cardiac arrest (OHCA), little is known about the impact of pneumonia and the optimal timing of antibiotic therapy after OHCA.
  
  
  METHODS
  We conducted a 5-year retrospective cohort study, including patients who suffered from OHCA and were treated with therapeutic hypothermia. ICU treatment was strictly standardized with defined treatment goals and procedures. Medical records, chest radiographic images and microbiological findings were reviewed.
  
  
  RESULTS
  Within the study period, 442 patients were admitted to our medical ICU after successfully resuscitated cardiac arrest. Of those, 174 patients fulfilled all inclusion and no exclusion criteria and were included into final analysis. Pneumonia within the first week could be confirmed in 39 patients (22.4%) and was confirmed or probable in 100 patients (57.5%), without a difference between survivors and non-survivors (37.8% vs. 23.1% confirmed pneumonia, p = 0.125). In patients with confirmed pneumonia a tracheotomy was performed more frequently (28.2 vs. 12.6%, p = 0.026) compared to patients without confirmed pneumonia. Importantly, patients with confirmed pneumonia had a longer ICU- (14.0 [8.5-20.0] vs. 8.0 [5.0-14.0] days, p < 0.001) and hospital stay (23.0 [11.5-29.0] vs. 15.0 [6.5-25.0] days, p = 0.016). A positive end expiratory pressure (PEEP) > =10.5 mbar on day 1 of the hospital stay was identified as early predictor of confirmed pneumonia (odds ratio 2.898, p = 0.006). No other reliable predictor could be identified. Median time to antibiotic therapy was 8.7 [5.4-22.8] hours, without a difference between patients with or without confirmed pneumonia (p = 0.381) and without a difference between survivors and non-survivors (p = 0.264). Patients receiving antibiotics within 12 hours after admission had a shorter ICU- (8.0 [4.0-14.0] vs. 10.5 [6.0-16.0] vs. 13.5 [8.0-20.0] days, p = 0.004) and hospital-stay (14.0 [6.0-25.0] vs. 16.5 [11.0-27.0] vs. 21.0 [17.0-28.0] days, p = 0.007) compared to patients receiving antibiotics after 12 to 36 or more than 36 hours, respectively.
  
  
  CONCLUSIONS
  Early pneumonia may extend length of ICU- and hospital-stay after OHCA and its occurrence is difficult to predict. A delayed initiation of antibiotic therapy in OHCA patients may increase the duration of the ICU- and hospital-stay.
authors.affiliation: Clinic for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. Kristian.Hellenkamp@medizin.uni-goettingen.de.
authors.forename: Kristian
authors.initials: K
authors.lastname: Hellenkamp
authors.affiliation: Clinic for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. s.onimischewski@gmail.com.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Onimischewski
authors.affiliation: Department of Medical Statistics, Georg-August-University Göttingen, Humboldtallee 32, Göttingen, 37073, Germany. jkruppa@gwdg.de.
authors.forename: Jochen
authors.initials: J
authors.lastname: Kruppa
authors.affiliation: Institute for Diagnostic and Interventional Radiology, Georg-August-University Göttingen, Robert-Koch-Straße 40, Göttingen, 37075, Germany. fasshauer@me.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Faßhauer
authors.affiliation: Clinic for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. abecker@med.uni-goettingen.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Becker
authors.affiliation: Institute for Medical Microbiology, Georg-August-University Göttingen, Kreuzbergring 57, Göttingen, 37075, Germany. heiffer@gwdg.de.
authors.forename: Helmut
authors.initials: H
authors.lastname: Eiffert
authors.affiliation: Clinic for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. huenlich@med.uni-goettingen.de.
authors.forename: Mark
authors.initials: M
authors.lastname: Hünlich
authors.affiliation: Clinic for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. hasenfus@med.uni-goettingen.de.
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.affiliation: Clinic for Cardiology & Pneumology/Heart Center, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. wachter@med.uni-goettingen.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Wachter
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality*; D011014:Pneumonia / Q000188:drug therapy* / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
references.citation: Clin Radiol. 2004 Aug;59(8):743-52
references.pmid: 15262550
references.citation: Crit Care Med. 2005 Jul;33(7):1538-48
references.pmid: 16003060
references.citation: Intensive Care Med. 2007 Oct;33(10):1800-4
references.pmid: 17576531
references.citation: Circulation. 2008 Dec 2;118(23):2452-83
references.pmid: 18948368
references.citation: Crit Care Med. 2009 Jul;37(7 Suppl):S223-6
references.pmid: 19535950
references.citation: J Crit Care. 2009 Sep;24(3):453-7
references.pmid: 19327318
references.citation: Resuscitation. 2010 Nov;81(11):1479-87
references.pmid: 20828914
references.citation: Resuscitation. 2010 Oct;81(10):1305-52
references.pmid: 20956049
references.citation: Resuscitation. 2010 Oct;81(10):1219-76
references.pmid: 20956052
references.citation: Crit Care Med. 2011 Jan;39(1):57-64
references.pmid: 20959789
references.citation: Crit Care Med. 2011 Jun;39(6):1359-64
references.pmid: 21336107
references.citation: Crit Care. 2011;15(2):144
references.pmid: 21489332
references.citation: Am J Respir Crit Care Med. 2011 Nov 1;184(9):1048-54
references.pmid: 21816940
references.citation: Resuscitation. 2013 May;84(5):616-9
references.pmid: 23153650
references.citation: Respir Care. 2013 Sep;58(9):1514-20
references.pmid: 23466424
references.citation: Circulation. 2014 Jan 21;129(3):e28-e292
references.pmid: 24352519
references.citation: Ann Pharmacother. 2014 Jan;48(1):17-25
references.pmid: 24259643
references.citation: Crit Care. 2013;17(1):R18
references.pmid: 23356570
references.citation: J Stroke Cerebrovasc Dis. 2015 Mar;24(3):680-6
references.pmid: 25601173
references.citation: Crit Care Med. 2015 Jun;43(6):1223-32
references.pmid: 25756419
references.citation: Resuscitation. 2015 Jul;92:154-9
references.pmid: 25680823
references.citation: Crit Care. 2015;19:283
references.pmid: 26202789