Microbiological profile of nosocomial infections following cardiac arrest : Insights from the targeted temperature management (TTM) trial

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Harmon, Matthew B.A.Academic Medical Center of University of Amsterdam (AMC) (författare)

Microbiological profile of nosocomial infections following cardiac arrest : Insights from the targeted temperature management (TTM) trial

Artikel/kapitelEngelska2020

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Elsevier BV,2020
7 s.

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LIBRIS-ID:oai:lup.lub.lu.se:473339a4-be9b-4ea7-b5ba-bdb87e8baa78
https://lup.lub.lu.se/record/473339a4-be9b-4ea7-b5ba-bdb87e8baa78URI
https://doi.org/10.1016/j.resuscitation.2019.11.033DOI

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Språk:engelska
Sammanfattning på:engelska

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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.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
Antibiotic prophylaxis
Antibiotics
Infections
Nosocomial infections
Temperature
TTM

Biuppslag (personer, institutioner, konferenser, titlar ...)

Hodiamont, C. J.Academic Medical Center of University of Amsterdam (AMC) (författare)
Dankiewicz, JosefLund University,Lunds universitet,Kardiologi,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,Cardiology,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital(Swepub:lu)med-jfd (författare)
Nielsen, NiklasLund University,Lunds universitet,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SEBRA Sepsis and Bacterial Resistance Alliance,Center for cardiac arrest,Lund University Research Groups,Helsingborg Hospital(Swepub:lu)med-nni (författare)
Schultz, Marcus J.Academic Medical Center of University of Amsterdam (AMC),Mahidol University (författare)
Horn, JannekeAcademic Medical Center of University of Amsterdam (AMC) (författare)
Friberg, HansLund University,Lunds universitet,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital(Swepub:lu)efor-hfr (författare)
Juffermans, Nicole P.Academic Medical Center of University of Amsterdam (AMC) (författare)
Academic Medical Center of University of Amsterdam (AMC)Kardiologi (creator_code:org_t)

Sammanhörande titlar

Ingår i:Resuscitation: Elsevier BV148, s. 227-2330300-9572

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Av författaren/redakt...: Harmon, Matthew ...; Hodiamont, C. J.; Dankiewicz, Jose ...; Nielsen, Niklas; Schultz, Marcus ...; Horn, Janneke; visa fler...; Friberg, Hans; Juffermans, Nico ...; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

Artiklar i publikationen: Resuscitation

Av lärosätet: Lunds universitet

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