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Article Dans Une Revue New England Journal of Medicine Année : 2019

Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

Bruno François
Alain Cariou
  • Fonction : Auteur
Raphaël Clere-Jehl
  • Fonction : Auteur
Pierre-François Dequin
Françoise Renon-Carron
  • Fonction : Auteur
Thomas Daix
Christophe Guitton
  • Fonction : Auteur
Nicolas Deye
  • Fonction : Auteur
Stéphane Legriel
Gaëtan Plantefève
  • Fonction : Auteur
Jean-Pierre Quenot
Arnaud Desachy
  • Fonction : Auteur
Toufik Kamel
  • Fonction : Auteur
Sandrine Bedon-Carte
  • Fonction : Auteur
Jean-Luc Diehl
  • Fonction : Auteur
Nicolas Chudeau
  • Fonction : Auteur
Elias Karam
  • Fonction : Auteur
  • PersonId : 772177
  • IdRef : 179968955
Isabelle Durand-Zaleski
  • Fonction : Auteur
Philippe Vignon
  • Fonction : Auteur
Amélie Le Gouge

Résumé

BACKGROUND: Patients who are treated with targeted temperature management after out-of-hospital cardiac arrest with shockable rhythm are at increased risk for ventilator-associated pneumonia. The benefit of preventive short-term antibiotic therapy has not been shown. METHODS: We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving adult patients (>18 years of age) in intensive care units (ICUs) who were being mechanically ventilated after out-of-hospital cardiac arrest related to initial shockable rhythm and treated with targeted temperature management at 32 to 34° C. Patients with ongoing antibiotic therapy, chronic colonization with multidrug-resistant bacteria, or moribund status were excluded. Either intravenous amoxicillin-clavulanate (at doses of 1 g and 200 mg, respectively) or placebo was administered three times a day for 2 days, starting less than 6 hours after the cardiac arrest. The primary outcome was early ventilator-associated pneumonia (during the first 7 days of hospitalization). An independent adjudication committee determined diagnoses of ventilator-associated pneumonia. RESULTS: A total of 198 patients underwent randomization, and 194 were included in the analysis. After adjudication, 60 cases of ventilator-associated pneumonia were confirmed, including 51 of early ventilator-associated pneumonia. The incidence of early ventilator-associated pneumonia was lower with antibiotic prophylaxis than with placebo (19 patients [19%] vs. 32 [34%]; hazard ratio, 0.53; 95% confidence interval, 0.31 to 0.92; P\,=\,0.03). No significant differences between the antibiotic group and the control group were observed with respect to the incidence of late ventilator-associated pneumonia (4% and 5%, respectively), the number of ventilator-free days (21 days and 19 days), ICU length of stay (5 days and 8 days if patients were discharged and 7 days and 7 days if patients had died), and mortality at day 28 (41% and 37%). At day 7, no increase in resistant bacteria was identified. Serious adverse events did not differ significantly between the two groups. CONCLUSIONS: A 2-day course of antibiotic therapy with amoxicillin-clavulanate in patients receiving a 32-to-34° C targeted temperature management strategy after out-of-hospital cardiac arrest with initial shockable rhythm resulted in a lower incidence of early ventilator-associated pneumonia than placebo. No significant between-group differences were observed for other key clinical variables, such as ventilator-free days and mortality at day 28. (Funded by the French Ministry of Health; ANTHARTIC ClinicalTrials.gov number, NCT02186951.).

Dates et versions

hal-03158790 , version 1 (04-03-2021)

Identifiants

Citer

Bruno François, Alain Cariou, Raphaël Clere-Jehl, Pierre-François Dequin, Françoise Renon-Carron, et al.. Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest. New England Journal of Medicine, 2019, 381 (19), pp.1831-1842. ⟨10.1056/NEJMoa1812379⟩. ⟨hal-03158790⟩
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