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Original Research: Critical Care |

Efficacy of Single-Dose Antibiotic Against Early-Onset Pneumonia in Comatose Patients Who Are VentilatedPreventing Pneumonia in Comatose Patients

Jordi Vallés, MD, PhD; Raquel Peredo, MD; Maria Jose Burgueño, MD, PhD; A. Patrícia Rodrigues de Freitas, MD; Susana Millán, MD; Mateu Espasa, MD; Ignacio Martín-Loeches, MD, PhD; Ricard Ferrer, MD, PhD; David Suarez, PhD; Antonio Artigas, MD, PhD
Author and Funding Information

From the Critical Care Center (Drs Vallés, Peredo, Burgueño, Millán, Martín-Loeches, Ferrer, and Artigas), Hospital Sabadell, Consorci Hospitalari Universitari Parc Taulí, CIBER Enfermedades Respiratorias, Sabadell, Spain; Emergency Medicine Service (Dr Rodrigues de Freitas), Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Microbiology Laboratory (Dr Espasa), UDIAT, Consorci Hospitalari Universitari Parc Taulí, Sabadell, Spain; and Epidemiology and Assessment Unit (Dr Suarez), Fundació Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain.

Correspondence to: Jordi Vallés, MD, PhD, Critical Care Center, Parc Taulí Hospital-Sabadell, Parc Tauli s/n. 08208 Sabadell, Spain; e-mail: jvalles@tauli.cat


For editorial comment see page 1195

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5):1219-1225. doi:10.1378/chest.12-1361
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Background:  Comatose patients present a high risk of early-onset ventilator-associated pneumonia (EO-VAP) for which antibiotic prophylaxis has been proposed. Comatose patients were studied to evaluate the efficacy of a single-dose of antibiotic prophylaxis at intubation against EO-VAP.

Methods:  A prospective cohort of comatose patients (Glasgow Coma Score ≤ 8) who were admitted in 2009-2010 and administered a single-dose of antibiotic within 4 h of intubation was compared with comatose patients (admitted ≥ 4 h after intubation in 2009-2010 or admitted in 2007-2008) who did not receive antibiotic prophylaxis. We analyzed the incidence of EO-VAP, late-onset VAP, and ventilator-associated tracheobronchitis in both groups. Propensity scores for receiving antibiotic prophylaxis were derived on the basis of patients’ characteristics (eg, age and severity) to assess its impact on EO-VAP development.

Results:  We included 129 patients (71 in the prophylaxis group and 58 in the control group). The global incidence of VAP and incidence of EO-VAP were lower in the prophylaxis group: 10.8 vs 28.4 episodes/1,000 days on mechanical ventilation (P = .015) and 4.4 vs 23.1 episodes/1,000 days on mechanical ventilation (P = .02), respectively. The incidence of late-onset VAP did not differ. The prophylaxis group tended toward lower incidence of ventilator-associated tracheobronchitis (15.5% vs 25.9%, P = .14). No differences in mortality were found between groups. The propensity-score regression analysis confirmed that a single dose of antibiotic prophylaxis was independently associated with lower incidence of EO-VAP (OR, 0.11; 95% CI, 0.02-0.58; P = .009).

Conclusions:  A single dose of antibiotic prophylaxis at intubation might lower the incidence of EO-VAP. However, a randomized clinical trial should be conducted to confirm our findings.

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