Cargando…

Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study

BACKGROUND: Patients resuscitated after cardiac arrest are reportedly at high risk for infection and sepsis, especially those treated with targeted temperature management (TTM). There is, however, limited evidence suggesting that early antibiotic use improves patient outcomes. We examined the hypoth...

Descripción completa

Detalles Bibliográficos
Autores principales: Tagami, Takashi, Matsui, Hiroki, Kuno, Masamune, Moroe, Yuuta, Kaneko, Junya, Unemoto, Kyoko, Fushimi, Kiyohide, Yasunaga, Hideo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055699/
https://www.ncbi.nlm.nih.gov/pubmed/27717334
http://dx.doi.org/10.1186/s12871-016-0257-3
_version_ 1782458798265335808
author Tagami, Takashi
Matsui, Hiroki
Kuno, Masamune
Moroe, Yuuta
Kaneko, Junya
Unemoto, Kyoko
Fushimi, Kiyohide
Yasunaga, Hideo
author_facet Tagami, Takashi
Matsui, Hiroki
Kuno, Masamune
Moroe, Yuuta
Kaneko, Junya
Unemoto, Kyoko
Fushimi, Kiyohide
Yasunaga, Hideo
author_sort Tagami, Takashi
collection PubMed
description BACKGROUND: Patients resuscitated after cardiac arrest are reportedly at high risk for infection and sepsis, especially those treated with targeted temperature management (TTM). There is, however, limited evidence suggesting that early antibiotic use improves patient outcomes. We examined the hypothesis that early treatment with antibiotics reduces mortality in patients with cardiac arrest receiving TTM. METHODS: We identified 2803 patients with cardiogenic out-of-hospital cardiac arrest (OHCA) that were treated with TTM and were admitted to 371 hospitals that contribute to the Japanese Diagnosis Procedure Combination inpatient database between July 2007 and March 2013. Of these, 1272 received antibiotics within the first 2 days (antibiotics) and 1531 did not (control). We generated 802 propensity score-matched pairs. RESULTS: There was no significant difference in 30-day mortality between the groups (control vs. antibiotics; 33.0 % vs. 29.9 %; difference, 3.1 %; 95 % confidence interval [CI], −1.4 to 7.7 %, p = 0.18). Analysis using the hospital antibiotics prescribing rate as an instrumental variable showed that antibiotic use was not significantly associated with a reduction in 30-day mortality (6.6 %, CI 95 %, −0.5 to 13.7 %, p = 0.28). A subgroup analysis of patients who required extracorporeal membrane oxygenation (ECMO) indicated a significant difference in 30-day mortality between the 2 groups (62.9 % vs. 43.5 %; difference 19.3 %, CI 95 %, 5.9 to 32.7 %, p = 0.005). In the instrumental variable model, the estimated reduction in 30-day mortality associated with antibiotics was 18.2 % (CI 95 %, 21.3 to 34.4 %, p = 0.03) in ECMO patients. CONCLUSIONS: Although there was no significant association between the use of antibiotics and mortality after overall cardiogenic OHCA treated with TTM, antibiotics may be beneficial in patients who require ECMO.
format Online
Article
Text
id pubmed-5055699
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-50556992016-10-19 Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study Tagami, Takashi Matsui, Hiroki Kuno, Masamune Moroe, Yuuta Kaneko, Junya Unemoto, Kyoko Fushimi, Kiyohide Yasunaga, Hideo BMC Anesthesiol Research Article BACKGROUND: Patients resuscitated after cardiac arrest are reportedly at high risk for infection and sepsis, especially those treated with targeted temperature management (TTM). There is, however, limited evidence suggesting that early antibiotic use improves patient outcomes. We examined the hypothesis that early treatment with antibiotics reduces mortality in patients with cardiac arrest receiving TTM. METHODS: We identified 2803 patients with cardiogenic out-of-hospital cardiac arrest (OHCA) that were treated with TTM and were admitted to 371 hospitals that contribute to the Japanese Diagnosis Procedure Combination inpatient database between July 2007 and March 2013. Of these, 1272 received antibiotics within the first 2 days (antibiotics) and 1531 did not (control). We generated 802 propensity score-matched pairs. RESULTS: There was no significant difference in 30-day mortality between the groups (control vs. antibiotics; 33.0 % vs. 29.9 %; difference, 3.1 %; 95 % confidence interval [CI], −1.4 to 7.7 %, p = 0.18). Analysis using the hospital antibiotics prescribing rate as an instrumental variable showed that antibiotic use was not significantly associated with a reduction in 30-day mortality (6.6 %, CI 95 %, −0.5 to 13.7 %, p = 0.28). A subgroup analysis of patients who required extracorporeal membrane oxygenation (ECMO) indicated a significant difference in 30-day mortality between the 2 groups (62.9 % vs. 43.5 %; difference 19.3 %, CI 95 %, 5.9 to 32.7 %, p = 0.005). In the instrumental variable model, the estimated reduction in 30-day mortality associated with antibiotics was 18.2 % (CI 95 %, 21.3 to 34.4 %, p = 0.03) in ECMO patients. CONCLUSIONS: Although there was no significant association between the use of antibiotics and mortality after overall cardiogenic OHCA treated with TTM, antibiotics may be beneficial in patients who require ECMO. BioMed Central 2016-10-07 /pmc/articles/PMC5055699/ /pubmed/27717334 http://dx.doi.org/10.1186/s12871-016-0257-3 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Tagami, Takashi
Matsui, Hiroki
Kuno, Masamune
Moroe, Yuuta
Kaneko, Junya
Unemoto, Kyoko
Fushimi, Kiyohide
Yasunaga, Hideo
Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study
title Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study
title_full Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study
title_fullStr Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study
title_full_unstemmed Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study
title_short Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study
title_sort early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055699/
https://www.ncbi.nlm.nih.gov/pubmed/27717334
http://dx.doi.org/10.1186/s12871-016-0257-3
work_keys_str_mv AT tagamitakashi earlyantibioticsadministrationduringtargetedtemperaturemanagementafteroutofhospitalcardiacarrestanationwidedatabasestudy
AT matsuihiroki earlyantibioticsadministrationduringtargetedtemperaturemanagementafteroutofhospitalcardiacarrestanationwidedatabasestudy
AT kunomasamune earlyantibioticsadministrationduringtargetedtemperaturemanagementafteroutofhospitalcardiacarrestanationwidedatabasestudy
AT moroeyuuta earlyantibioticsadministrationduringtargetedtemperaturemanagementafteroutofhospitalcardiacarrestanationwidedatabasestudy
AT kanekojunya earlyantibioticsadministrationduringtargetedtemperaturemanagementafteroutofhospitalcardiacarrestanationwidedatabasestudy
AT unemotokyoko earlyantibioticsadministrationduringtargetedtemperaturemanagementafteroutofhospitalcardiacarrestanationwidedatabasestudy
AT fushimikiyohide earlyantibioticsadministrationduringtargetedtemperaturemanagementafteroutofhospitalcardiacarrestanationwidedatabasestudy
AT yasunagahideo earlyantibioticsadministrationduringtargetedtemperaturemanagementafteroutofhospitalcardiacarrestanationwidedatabasestudy