- Poster presentation
- Published:
Retrospective analysis of respiratory isolates post out-of-hospital cardiac arrest to establish choices in empirical antibiotic cover
Critical Care volume 18, Article number: P353 (2014)
Introduction
We analysed positive respiratory isolates for antibiotic resistance in our out-of-hospital cardiac arrest (OOHCA) population to establish adequacy of current empirical regimes. Pneumonia commonly complicates OOHCA, with studies suggesting a prevalence up to 48% [1].
Methods
Patients admitted to the ICU between May 2007 and September 2013 who underwent therapeutic hypothermia post OOHCA were included in this study. Demographics and antibiotic resistance were collected from an electronic database.
Results
A total of 160 patients were admitted to the ICU post OOHCA. In total, 37.5% (60/160) had no respiratory sample sent within 72 hours of admission and were excluded. Forty per cent (40/100) grew a clinically important isolate. Gram-negative bacteria (GNB) were most frequently isolated (42.5%, 17/40) followed by Gram-positive bacteria (32.5%, 13/40) and mixed bacterial growth (25%, 10/40). S. aureus (n = 14) isolates were often resistant to penicillin (92.8%, 13/14 isolates tested) but maintained macrolide (erythromycin 92.8%, 13/14), clindamycin (92.8%, 13/14) and vancomycin (100%, 13/13) sensitivity, if tested. S. pneumoniae isolates (n = 8) maintained penicillin (87.5%, 7/8), levofloxacin (100%, 6/6), erythromycin (87.5%, 7/8) and vancomycin (100%, 6/6) sensitivity. The most commonly isolated GNB, H. influenzae, maintained high-level sensitivity to amoxicillin (81.8%, 9/11) and co- amoxiclav (90.9%, 10/11). Other isolated GNB, however, demonstrated variable resistance to co-amoxiclav (69.2%, 9/13). Isolates were 100% sensitive to pipericillin-tazobactam (17/17), amikacin (12/12) and meropenem (16/16). The British Thoracic Society suggests co-amoxiclav and clarithromycin for first-line treatment of severe community- acquired pneumonia [2]. Based on this, 77.5% (31/40) of our patients would have received adequate cover. If pipericillin-tazobactam replaced co-amoxiclav, 95% (38/40) of our patients would have been treated with appropriate antibiotics.
Conclusion
Respiratory samples post OOHCA frequently grow potentially pathogenic bacteria but current antibiotic guidelines fail to provide adequate cover in this population.
References
Nielsen N, et al.: Adverse events and their relation to mortality in out-ofhospital cardiac arrest patients treated with therapeutic hypothermia. Crit CareMed 2011, 39: 57-64.
Lim WS: BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009, 64: 1-55.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Wong, J., Harb, H., Bamford, K. et al. Retrospective analysis of respiratory isolates post out-of-hospital cardiac arrest to establish choices in empirical antibiotic cover. Crit Care 18 (Suppl 1), P353 (2014). https://doi.org/10.1186/cc13543
Published:
DOI: https://doi.org/10.1186/cc13543