Abstract
AimsInfectious 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. MethodsThis 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. ResultsOf 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. ConclusionGram-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.
Highlights
Infectious complications are common in cardiac arrest patients and may contribute to mortality.1À5 The high rate of nosocomial infections may be due to an impaired immune response following cardiac arrest.[6]
We describe the microbiological profile of nosocomial infections in patients with cardiac arrest and examined the impact of to a temperature of 33 C (TTM33) compared to TTM36 on this profile
Within the temperature management (TTM)-trial patients were randomized to a temperature of 33 C (TTM33) or 36 C (TTM36). 28 h after randomization patients were gradually rewarmed to 37 C at a maximum speed of 0.5 C per hour
Summary
Infectious complications are common in cardiac arrest patients and may contribute to mortality.1À5 The high rate of nosocomial infections may be due to an impaired immune response following cardiac arrest.[6]. Discrepancies between studies may be explained by difficulties in diagnosis of infections during temperature management strategies, due to temperature modulation and due to systemic inflammatory reaction following a cardiac arrest. Difficulties in diagnosing infection may result in delay in initiation of antibiotic treatment[8,9] with subsequent increased duration of ICU- and hospital-stay.[10] This may prompt the question whether the use of prophylactic antibiotics may reduce infectious complications in cardiac arrest patients. Antibiotic use in the first 7 days following cardiac arrest was associated with improved survival[8] and a four-fold reduction of pneumonia.[11]
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