Antibiotics after major aspiration: no clear benefit

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Takeaway

  • This single-center retrospective study found no mortality benefit of antibiotic prophylaxis after major aspiration.
  • Authors recommend sticking to supportive care for acute aspiration pneumonitis (AAP).

Why this matters

  • During AAP, patients are commonly prescribed prophylactic antibiotics to prevent secondary bacterial pneumonia, but evidence is lacking.
  • Routine prophylaxis could heighten antibiotic resistance and/or Clostridium difficile infection risk.

Key results

  • Univariate analysis:
    • 34 (17%) patients required critical care transfer and 9 (4%) died;
    • 30-day in-hospital mortality: prophylaxis group, 25%; supportive-care group, 25% (P=1);
    • Prophylaxis vs supportive care: similar critical care transfers (5% vs 6%; P=.7); fewer antibiotic-free days (7.5 vs 10.9; P<.0001 antibiotic escalation vs p=".002).</li">
  • In multivariate analysis, similar 30-day in-hospital mortality with prophylaxis vs supportive care (OR, 0.9; P=.7).

Study design

  • Single-center retrospective cohort study (6-year chart review by researchers blinded to prophylaxis status).
  • 200 adults with documented AAP event, without preexisting pneumonia included.
  • Researchers compared outcomes after antimicrobial prophylaxis (n=76) vs supportive care only (n=124) during first 2 days after aspiration episode.
  • Primary outcome: 30-day in-hospital mortality.
  • Funding: None disclosed.

Limitations

  • Study underpowered to detect
  • Pneumonia not considered as an outcome.
  • Results not generalizable to patients with silent aspiration events.