- 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.
- 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); more antibiotic escalation (8% vs 1%; P=.002).
- In multivariate analysis, similar 30-day in-hospital mortality with prophylaxis vs supportive care (OR, 0.9; P=.7).
- 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.
- Study underpowered to detect <10% mortality difference.
- Pneumonia not considered as an outcome.
- Results not generalizable to patients with silent aspiration events.