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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 LU orcid ; Nielsen, Niklas LU ; Schultz, Marcus J. ; Horn, Janneke ; Friberg, Hans LU and Juffermans, Nicole P. (2020) In Resuscitation 148. p.227-233
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... (More)

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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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Antibiotic prophylaxis, Antibiotics, Infections, Nosocomial infections, Temperature, TTM
in
Resuscitation
volume
148
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85079364726
  • pmid:32032651
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2019.11.033
language
English
LU publication?
yes
id
473339a4-be9b-4ea7-b5ba-bdb87e8baa78
date added to LUP
2020-02-26 15:57:24
date last changed
2024-06-12 09:40:59
@article{473339a4-be9b-4ea7-b5ba-bdb87e8baa78,
  abstract     = {{<p>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.</p>}},
  author       = {{Harmon, Matthew B.A. and Hodiamont, C. J. and Dankiewicz, Josef and Nielsen, Niklas and Schultz, Marcus J. and Horn, Janneke and Friberg, Hans and Juffermans, Nicole P.}},
  issn         = {{0300-9572}},
  keywords     = {{Antibiotic prophylaxis; Antibiotics; Infections; Nosocomial infections; Temperature; TTM}},
  language     = {{eng}},
  month        = {{03}},
  pages        = {{227--233}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Microbiological profile of nosocomial infections following cardiac arrest : Insights from the targeted temperature management (TTM) trial}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2019.11.033}},
  doi          = {{10.1016/j.resuscitation.2019.11.033}},
  volume       = {{148}},
  year         = {{2020}},
}