title: Prophylactic versus clinically-driven antibiotics in comatose survivors of out-of-hospital cardiac arrest-A randomized pilot study.
abstract: To investigate benefits of prophylactic antibiotics in comatose survivors of out-of-hospital cardiac arrest (OHCA).
  
  
  
  Patients without evidence of tracheobronchial aspiration on admission bronchoscopy were randomized to prophylactic Amoxicillin-Clavulanic acid 1.2g every 8h (P) or clinically-driven antibiotics (C) administered if signs of infection developed during initial 7days of intensive care unit (ICU) stay.
  
  
  
  Among 83 patients enrolled between September 2013 and February 2015, tracheobronchial aspiration was documented in 23 (28%). Accordingly, 60 patients were randomized. Percentage of patients on antibiotics between days 1-5 was significantly greater in P group. White blood count, C-reactive protein, procalcitonin (PCT) and CD 64 significantly increased during the postresuscitation phase. Except for lower CRP and PCT in group P on day 6 (p<0.05), there was no significant differences. Mini BAL on day 3 was less often positive in group P (7% vs. 42%; p<0.01). There was no significant difference in other microbiological samples and X-ray signs of pneumonia cumulatively documented in 50% in both groups. Use of vasopressors/inotropes (93% in both groups), duration of mechanical ventilation (5.4±3.7 vs. 5.2±3.1 days), tracheal intubation (6.5±4.6 vs. 5.9±4.3 days), ICU stay (7.7±5.2 vs. 6.9±4.5 days), survival (73% vs. 73%) and survival with good neurological outcome (50% vs. 40%) were also comparable between P and C groups.
  
  
  
  Bronchoscopy on admission documented tracheobronchial aspiration in 28% of comatose survivors of OHCA. In the absence of aspiration, prophylactic antibiotics did not significantly alter systemic inflammatory response, postresuscitation pneumonia, ICU treatment and outcome (ClinicalTrials.gov Identifier: NCT02899507).
authors.affiliation: Center for Intensive Therapy, Department of Anesthesiology and Intensive therapy, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Suada Filekovic
authors.initials: SF
authors.lastname: Ribaric
authors.affiliation: Department of Pulmonary Diseases and Allergy, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Matjaz
authors.initials: M
authors.lastname: Turel
authors.affiliation: Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Rihard
authors.initials: R
authors.lastname: Knafelj
authors.affiliation: Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Vojka
authors.initials: V
authors.lastname: Gorjup
authors.affiliation: Center for Intensive Therapy, Department of Anesthesiology and Intensive therapy, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Rade
authors.initials: R
authors.lastname: Stanic
authors.affiliation: Center for Intensive Therapy, Department of Anesthesiology and Intensive therapy, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Primoz
authors.initials: P
authors.lastname: Gradisek
authors.affiliation: Center for Intensive Therapy, Department of Anesthesiology and Intensive therapy, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Cerovic
authors.affiliation: Center for Intensive Therapy, Department of Anesthesiology and Intensive therapy, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia.
authors.forename: Tomislav
authors.initials: T
authors.lastname: Mirkovic
authors.affiliation: Center for Intensive Internal Medicine, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia. Electronic address: marko.noc@mf.uni-lj.si.
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
mesh_terms: D000368:Aged; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003128:Coma / Q000150:complications; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications*; D010865:Pilot Projects
chemical_list: D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination
keywords: Hypothermia; Out-of-hospital cardiac arrest; Prophylactic antibiotic treatment