Short-term antibiotic therapy for preventing ventilator-associated pneumonia after cardiac arrest

  • François B & al.
  • N Engl J Med
  • 7 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients treated with targeted temperature management (32-to-34°C) after out-of-hospital cardiac arrest with an initial shockable rhythm, short-term (2 days) treatment with amoxicillin-clavulanate reduced the incidence of early ventilator-associated pneumonia compared with placebo.

Why this matters

  • The risk for ventilator-associated pneumonia is higher in patients who are treated with targeted temperature management after out-of-hospital cardiac arrest with shockable rhythm. The benefit of preventive short-term antibiotic therapy has not been shown.

Study design

  • ANTHARTIC trial included 194 patients treated with targeted temperature management (32-34°C) after out-of-hospital cardiac arrest with a shockable rhythm who were randomly assigned to receive antibiotic (amoxicillin-clavulanate; 1g/200mg; n=99) or placebo (n=95) for 2 days.
  • Primary outcome: early ventilator-associated pneumonia (during the first 7 days of hospitalisation).
  • Funding: French Ministry of Health.

Key results

  • Incidence of early ventilator-associated pneumonia was significantly lower in the antibiotic vs placebo group (19% vs 34%; HR, 0.53; 95% CI, 0.31-0.92; P=.03).
  • No significant differences were observed between both groups with respect to;
    • incidence of late ventilator-associated pneumonia (4% vs. 5%),
    • ventilator-free days (21 days vs 19 days),
    • ICU length of stay (in case of discharge: 5 days vs 8 days; death: 7 days vs 7 days), and  
    • mortality at day-28 (41% vs. 37%).
  • No significant difference was observed between antibiotic and placebo group in:
    • multidrug-resistant bacteria at 7 days (1 vs 7) and
    • serious adverse events (55 vs 52; difference in incidence, 4 percentage points; 95% CI, -10 to 18).

Limitations

  • Patients with overt aspiration were not included.