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Association of antimicrobial use and incidence of hospital-acquired pneumonia in critically ill trauma patients with pulmonary contusion: an observational study
Bassi, Estevão; Merighi, Camila Trevizani; Tomizuka, Carlos Issamu; Guimarães, Thais; Novo, Fernando da Costa Ferreira; Damous, Sergio Henrique Bastos; Utiyama, Edivaldo Massazo; Malbouisson, Luiz Marcelo Sá.
Afiliación
  • Bassi, Estevão; Universidade de São Paulo. Faculdade de Mediana. Hospital das Clínicas (HCFMUSP). São Paulo. BR
  • Merighi, Camila Trevizani; Universidade de São Paulo. Faculdade de Mediana. Hospital das Clínicas (HCFMUSP). São Paulo. BR
  • Tomizuka, Carlos Issamu; Universidade de São Paulo. Faculdade de Mediana. Hospital das Clínicas (HCFMUSP). São Paulo. BR
  • Guimarães, Thais; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas (HCFMUSP). São Paulo. BR
  • Novo, Fernando da Costa Ferreira; Universidade de São Paulo. Faculdade de Mediana. Hospital das Clínicas (HCFMUSP). São Paulo. BR
  • Damous, Sergio Henrique Bastos; Universidade de São Paulo. Faculdade de Mediana. Hospital das Clínicas (HCFMUSP). São Paulo. BR
  • Utiyama, Edivaldo Massazo; Universidade de São Paulo. Faculdade de Mediana. Hospital das Clínicas (HCFMUSP). São Paulo. BR
  • Malbouisson, Luiz Marcelo Sá; Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas (HCFMUSP). São Paulo. BR
Braz. j. anesth ; 74(3): 744454, 2024. tab, graf
Article en En | LILACS-Express | LILACS | ID: biblio-1564095
Biblioteca responsable: BR1.1
Ubicación: 0034-7094-bja-74-03-744454.xml
ABSTRACT
Abstract

Background:

Pneumonia occurs in about 20% of trauma patients with pulmonary contusions. This study aims to evaluate the association between empirical antibiotic therapy and nosocomial pneumonia in this population.

Methods:

Retrospective cohort of adult patients admitted to a trauma-surgical ICU. The Antibiotic Therapy Group (ATG) was defined by intravenous antibiotic use for more than 48 h starting on hospital admission, while the Conservative Group (CG) was determined by antibiotic use no longer than 48 h. Primary outcome was microbiologically documented nosocomial pneumonia within 14 days after hospital admission. Logistic regression was used to estimate the association between group allocation and primary outcome. Exploratory analyses evaluating the association between resistant strains in pneumonia and antibiotic use were performed.

Results:

The study included 177 patients with chest trauma and pulmonary contusion on CTscan. ATG were more severely ill than CG, as shown by higher Injury Severity Score, SAPS3, SOFA score, higher rates, and longer duration of mechanical ventilation. In the multivariate analysis, ATG was associated with a lower incidence of primary outcome (OR = 0.25, 95% CI 0.09-0.64; p < 0.01). Similar results were found in the sensitivity analysis with another set of variables. However, each day of antibiotic use was associated with an increased risk of pneumonia by resistant bacteria (OR = 1.18 per day, 95% CI 1.05-1.36; p < 0.01).

Conclusions:

Empiric antibiotic therapy was independently associated with lower incidence of nosocomial pneumonia in critically ill patients with pulmonary contusion. However, each day of antibiotic use was associated with increased resistant strains in infected patients.
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Texto completo: 1 Colección: 01-internacional Base de datos: LILACS Idioma: En Revista: Braz. j. anesth Año: 2024 Tipo del documento: Article País de afiliación: Brasil
Texto completo
Añadir a Mi BVS
Imprimir
XML
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: LILACS Idioma: En Revista: Braz. j. anesth Año: 2024 Tipo del documento: Article País de afiliación: Brasil