Prophylactic versus clinically-driven antibiotics in comatose survivors of-out-of-hospital cardiac arrest-A randomized pilot study

Aim: To investigate benefits of prophylactic antibiotics in comatose survivors of out-of-hospital cardiac arrest (OHCA). Methods: Patients without evidence of tracheobronchial aspiration on admission bronchoscopy were randomized to prophylactic Amoxicillin-Clavulanic acid 1.2 g every 8 h (P) or clinically-driven antibiotics (C) administered if signs of infection developed during initial 7 days of intensive care unit (ICU) stay. Results: Among 83 patients enrolled between September 2013 and February 2015, tracheobronchial aspiration was documented in 23 (28%). Accordingly, 60 patients were randomized. Percentage of patients on antibiotics between days 1-5 was significantly greater in P group. White blood count, C-reactive protein, procalcitonin (PCT) and CD 64 significantly increased during the postresuscitation phase. Except for lower CRP and PCT in group P on day 6 (p < 0.05), there was no significant differences. Mini BAL on day 3 was less often positive in group P (7% vs. 42%; p < 0.01). There was no significant difference in other microbiological samples and X-ray signs of pneumonia cumulatively documented in 50% in both groups. Use of vasopressors/inotropes (93% in both groups), duration of mechanical ventilation (5.4 +/- 3.7 vs. 5.2 +/- 3.1 days), tracheal intubation (6.5 +/- 4.6 vs. 5.9 +/- 4.3 days), ICU stay (7.7 +/- 5.2 vs. 6.9 +/- 4.5 days), survival (73% vs. 73%) and survival with good neurological outcome (50% vs. 40%) were also comparable between P and C groups. Conclusion: Bronchoscopy on admission documented tracheobronchial aspiration in 28% of comatose survivors of OHCA. In the absence of aspiration, prophylactic antibiotics did not significantly alter systemic inflammatory response, postresuscitation pneumonia, ICU treatment and outcome (ClinicalTrials. gov Identifier: NCT02899507). (C) 2016 Elsevier Ireland Ltd. All rights reserved.