Influence of Single-Dose Antibiotic Prophylaxis for Early-Onset Pneumonia in High-Risk Intubated Patients

Overview

Journal Neurocrit Care

Specialty Critical Care

Date 2018 Jan 10

PMID 29313312

Citations 2

Authors

Timothy D Lewis

Kelly A Dehne

Kathryn Morbitzer

Denise H Rhoney

Casey Olm-Shipman

J Dedrick Jordan

Affiliations

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Abstract

Background: Early-onset pneumonia (EOP) after endotracheal intubation is common among critically ill patients with a neurologic injury and is associated with worse clinical outcomes.

Methods: This retrospective cohort study observed outcomes pre- and post-implementation of an EOP prophylaxis protocol which involved the administration of a single dose of ceftriaxone 2 g around the time of intubation. The study included patients ≥ 18 years who were admitted to the University of North Carolina Medical Center (UNCMC) neuroscience intensive care unit (NSICU) between April 1, 2014, and October 26, 2016, and intubated for ≥ 72 h.

Results: Among the 172 patients included, use of an EOP prophylaxis protocol resulted in a significant reduction in the rate of microbiologically confirmed EOP compared to those without prophylaxis (7.4 vs 19.8%, p = 0.026). However, EOP prophylaxis did not decrease the combined incidence of microbiologically confirmed or clinically suspected EOP (32.2 vs 37.4%, p = 0.523). No difference in the rate of late-onset pneumonia (34.6 vs 26.4%, p = 0.25) or virulent organism growth (19.8 vs 14.3%, p = 0.416) was observed. No difference was observed in the duration of intubation, duration of intensive care unit (ICU) stay, duration of hospitalization, or ICU antibiotic days within 30 days of intubation. In hospital mortality was found to be higher in those who received EOP prophylaxis compared to those who did not receive prophylaxis (45.7 vs 29.7%, p = 0.04).

Conclusions: The administration of a single antibiotic dose following intubation may reduce the incidence of microbiologically confirmed EOP in patients with neurologic injury who are intubated ≥ 72 h. A prophylaxis strategy does not appear to increase the rate of virulent organism growth or the rate of late-onset pneumonia. However, this practice is not associated with a decrease in days of antibiotic use in the ICU or any clinical outcomes benefit.

Citing Articles

Prophylactic antibiotics for preventing ventilator-associated pneumonia: a pairwise and Bayesian network meta-analysis.

Zha S, Niu J, He Z, Fu W, Huang Q, Guan L Eur J Med Res. 2023; 28(1):348.

PMID: 37715208 PMC: 10503075. DOI: 10.1186/s40001-023-01323-z.

[Update of the recommendations of the Pneumonia Zero project].

Arias-Rivera S, Jam-Gatell R, Nuvials-Casals X, Vazquez-Calatayud M Enferm Intensiva. 2022; 33:S17-S30.

PMID: 35911624 PMC: 9326456. DOI: 10.1016/j.enfi.2022.05.005.

References

Klompas M, Branson R, Eichenwald E, Greene L, Howell M, Lee G . Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014; 35 Suppl 2:S133-54. DOI: 10.1017/s0899823x00193894. View

Lepelletier D, Roquilly A, Demeure Dit Latte D, Mahe P, Loutrel O, Champin P . Retrospective analysis of the risk factors and pathogens associated with early-onset ventilator-associated pneumonia in surgical-ICU head-trauma patients. J Neurosurg Anesthesiol. 2009; 22(1):32-7. DOI: 10.1097/ANA.0b013e3181bdf52f. View

Bronchard R, Albaladejo P, Brezac G, Geffroy A, Seince P, Morris W . Early onset pneumonia: risk factors and consequences in head trauma patients. Anesthesiology. 2004; 100(2):234-9. DOI: 10.1097/00000542-200402000-00009. View

Esnault P, Nguyen C, Bordes J, dAranda E, Montcriol A, Contargyris C . Early-Onset Ventilator-Associated Pneumonia in Patients with Severe Traumatic Brain Injury: Incidence, Risk Factors, and Consequences in Cerebral Oxygenation and Outcome. Neurocrit Care. 2017; 27(2):187-198. DOI: 10.1007/s12028-017-0397-4. View

Acquarolo A, Urli T, Perone G, Giannotti C, Candiani A, Latronico N . Antibiotic prophylaxis of early onset pneumonia in critically ill comatose patients. A randomized study. Intensive Care Med. 2005; 31(4):510-6. DOI: 10.1007/s00134-005-2585-5. View

Ewig S, Torres A, Fabregas N, Hernandez C, Gonzalez J, Nicolas J . Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia. Am J Respir Crit Care Med. 1999; 159(1):188-98. DOI: 10.1164/ajrccm.159.1.9803097. View

Rolfe R, Finegold S . Comparative in vitro activity of ceftriaxone against anaerobic bacteria. Antimicrob Agents Chemother. 1982; 22(2):338-41. PMC: 183738. DOI: 10.1128/AAC.22.2.338. View

Lascarrou J, Lissonde F, Le Thuaut A, Bachoumas K, Colin G, Henry Lagarrigue M . Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis. Crit Care Med. 2017; 45(8):1268-1275. DOI: 10.1097/CCM.0000000000002525. View

Valles J, Peredo R, Burgueno M, Rodrigues de Freitas A, Millan S, Espasa M . Efficacy of single-dose antibiotic against early-onset pneumonia in comatose patients who are ventilated. Chest. 2013; 143(5):1219-1225. DOI: 10.1378/chest.12-1361. View

10.

Sirvent J, Torres A, Castro P, de Batlle J, Bonet A . Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma. Am J Respir Crit Care Med. 1997; 155(5):1729-34. DOI: 10.1164/ajrccm.155.5.9154884. View

11.

Langer M, Cigada M, Mandelli M, Mosconi P, Tognoni G . Early onset pneumonia: a multicenter study in intensive care units. Intensive Care Med. 1987; 13(5):342-6. DOI: 10.1007/BF00255791. View