December 23, 2019
A 2-day course of antibiotic therapy can lower the risk of ventilator-associated pneumonia among patients being treated with targeted temperature management after out-of-hospital cardiac arrest with shockable rhythm, according to results of a new study.
To reach this conclusion, the researchers analyzed data on 194 patients older than age 18 years who were in intensive care units (ICUs). Patients included in the analysis were being mechanically ventilated after out-of-hospital cardiac arrest related to initial shockable rhythm and treated with targeted temperature management at 32°C to 34°C. Individuals with ongoing antibiotic therapy, chronic colonization with multidrug-resistant bacteria, or moribund status were excluded.
The patients were randomly assigned to receive either intravenous amoxicillin, 1 g, plus clavulanate, 200 mg, or placebo. The assigned therapy was administered 3 times a day for 2 days, starting less than 6 hours after the cardiac arrest.
The researchers assessed for early ventilator-associated pneumonia—defined as acquiring the infection during the first 7 days of hospitalization—among both the amoxicillin-clavulanate and placebo groups.
Overall, there were 60 confirmed cases of ventilator-associated pneumonia, 51 of which occurred during the first 7 days of hospitalization. Of these 51 cases, 19 were from the antibiotic prophylaxis group and 32 were from the placebo group.
While the incidence of early ventilator-associated pneumonia was lower among the antibiotic group than the placebo group, there was no significant difference between the 2 groups in incidence of late ventilator-associated pneumonia. There were also no significant differences in the number of ventilator-free days, ICU length of stay, mortality at day 28, or occurrence of serious adverse events between the groups.
According to the study authors, resistant bacteria had not increased when analyzed at day 7.
François B, Cariou A, Clere-Jehl R, et al; CRICS-TRIGGERSEP Network, ANTHARTIC Study Group. Prevention of early ventilator-associated pneumonia after cardiac arrest. N Engl J Med. 2019;381:1831-1842. doi:10.1056/NEJMoa1812379.