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Microbiological profile of nosocomial infections following cardiac arrest: Insights from the targeted temperature management (TTM) trial.
Harmon, Matthew B A; Hodiamont, C J; Dankiewicz, Josef; Nielsen, Niklas; Schultz, Marcus J; Horn, Janneke; Friberg, Hans; Juffermans, Nicole P.
Afiliação
  • Harmon MBA; Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam, The Netherlands.
  • Hodiamont CJ; Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands; Department of Microbiology, Academic Medical Centre, Amsterdam, The Netherlands.
  • Dankiewicz J; Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden.
  • Nielsen N; Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden; Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
  • Schultz MJ; Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam, The Netherlands; Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand.
  • Horn J; Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam, The Netherlands.
  • Friberg H; Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Getingevägen, 22185 Lund, Sweden.
  • Juffermans NP; Department of Intensive Care, Academic Medical Centre, Amsterdam, The Netherlands; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam, The Netherlands. Electronic address: n.p.juffermans@amc.uva.nl.
Resuscitation ; 148: 227-233, 2020 03 01.
Article em En | MEDLINE | ID: mdl-32032651
ABSTRACT

AIMS:

Infectious complications frequently occur in intensive care unit patients admitted after out-of-hospital cardiac arrest. There is debate on the effects of temperature management on the incidence of infections, as well as on the efficacy and choice of antibiotic prophylaxis. In this substudy of the targeted temperature management (TTM) trial, we describe the microbiological profile of infectious complications in patients with cardiac arrest and examined the impact of TTM at 33 °C compared to TTM at 36 °C. Furthermore we aimed to determine the association between antibiotic prophylaxis and the incidence of infections.

METHODS:

This is a posthoc analysis of the TTM cohort. Microbiological data was retrospectively collected for the first 14-days of ICU-admission. Logistic regression was used to determine the relationship between antibiotic prophylaxis and pneumonia adjusted for mortality.

RESULTS:

Of 696 patients included in this analysis, 158 (23%) developed pneumonia and 28 (4%) had bacteremia with a clinically relevant pathogen. Staphylococcus aureus was the most common pathogen isolated in patients with pneumonia (23%) and in patients with bacteremia (24%). Gram-negative pathogens were most common overall. TTM did not have an impact on the microbiological profile. The use of antibiotic prophylaxis was significantly associated with a reduced risk of infection (OR 0.59, 95%CI 0.43-0.79, p = 0.0005). This association remained significant after correcting for confounders (OR 0.64, 95%CI 0.46-0.90; p = 0.01). The association is not present in a model after correction for clustering within centers (aOR 0.55, 95%CI 0.20-1.47, p = 0.22). Adjustment for mortality did not influence the outcome.

CONCLUSION:

Gram-negative pathogens are the most common causes of nosocomial infections following cardiac arrest. TTM does not impact the microbiological profile. It remains unclear whether patients in ICUs using antibiotic prophylaxis have a reduced risk of pneumonia and bacteremia that is unrelated to center effects.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecção Hospitalar / Parada Cardíaca Extra-Hospitalar / Hipotermia Induzida Tipo de estudo: Observational_studies Limite: Humans Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecção Hospitalar / Parada Cardíaca Extra-Hospitalar / Hipotermia Induzida Tipo de estudo: Observational_studies Limite: Humans Idioma: En Ano de publicação: 2020 Tipo de documento: Article