Blood Cultures and Appropriate Antimicrobial Administration after Achieving Sustained Return of Spontaneous Circulation in Adults with Nontraumatic Out-of-Hospital Cardiac Arrest.

Chih-Hao Lin,Yi-Tzu Huang,William Yu Chung Wang,Ching-Yu Ho,Ching-Chi Lee,Wen-Chien Ko,Po-Lin Chen,Chih-Chia Hsieh

doi:10.3390/antibiotics10070876

Abstract

We aimed to determine the incidence of bacteremia and prognostic effects of prompt administration of appropriate antimicrobial therapy (AAT) on nontraumatic out-of-hospital cardiac arrest (OHCA) patients achieving a sustained return of spontaneous circulation (sROSC), compared with non-OHCA patients. In the multicenter case-control study, nontraumatic OHCA adults with bacteremia episodes after achieving sROSC were defined as case patients, and non-OHCA patients with community-onset bacteremia in the emergency department were regarded as control patients. Initially, case patients had a higher bacteremia incidence than non-OHCA visits (231/2171, 10.6% vs. 10,430/314,620, 3.3%; p < 0.001). Compared with the matched control (2288) patients, case (231) patients experienced more bacteremic episodes due to low respiratory tract infections, fewer urosepsis events, fewer Escherichia coli bacteremia, and more streptococcal and anaerobes bacteremia. Antimicrobial-resistant organisms, such as methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing Enterobacteriaceae, were frequently evident in case patients. Notably, each hour delay in AAT administration was associated with an average increase of 10.6% in crude 30-day mortality rates in case patients, 0.7% in critically ill control patients, and 0.3% in less critically ill control patients. Conclusively, the incidence and characteristics of bacteremia differed between the nontraumatic OHCA and non-OHCA patients. The incorporation of blood culture samplings and rapid AAT administration as first-aids is essential for nontraumatic OHCA patients after achieving sROSC.

Highlights

Bloodstream infections are associated with substantial morbidity and mortality that cause a significant burden of healthcare costs [1]
The contamination rates of blood cultures (7.1% vs. 1.8%, p < 0.001) and true bacteremia incidence (10.6% vs. 3.3%, p < 0.001) in nontraumatic of-hospital cardiac arrest (OHCA) patients with sustained return of spontaneous circulation (sROSC) were significantly higher than those in non-OHCA patients (Figure 1)
Based on the inclusion and exclusion criteria, the study cohort of community-onset bacteremia consisted of 231 case patients and 2288 matched control patients (Figure 1)

Summary

Introduction

Bloodstream infections are associated with substantial morbidity and mortality that cause a significant burden of healthcare costs [1]. The emergency department (ED) physicians do not include blood cultures to be a routine test after achieving ROSC and do not administer antimicrobial therapy as the first aid for patients initially experiencing OHCA. We hypothesized that if OHCA presentation is accompanied by a high incidence of bacteremia and prompt AAT administration has a beneficial effect on the short-term prognoses of OHCA patients with bacteremia, rapid AAT administration would be crucial for surviving nontraumatic OHCA patients after achieving ROSC. This study aimed to investigate the characteristics and incidence of bacteremia in nontraumatic OHCA adults compared with non-OHCA patients, and to elucidate the prognostic effect of prompt AAT administration on those achieving sustained ROSC (sROSC)

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