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Research
Blood Cultures and Broad-Spectrum Antimicrobials are Essential for Patients with Out-of-Hospital Cardiac Arrest
Ching-Chi Lee
National Cheng Kung University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4949-2742
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Etiologies of out-of-hospital cardiac arrest (OHCA) have been majorly focused on cardiac origins. Little is known regarding the role of bloodstream infections (BSIs) in OHCA episodes. Our aim was to disclose clinical features and incidences of BSIs and the survival benefit of prompt administration of appropriate antimicrobial therapy (AAT) in adults with OHCA.
Methods: In the 10-year multicenter cohort, clinical information was retrospectively collected and causative microorganisms were prospectively stored for species identification and susceptibilities. The effect of delayed AAT administration on 30-day mortality was examined after adjustment for independent predictors of mortality, recognized by a multivariate regression analysis.
Results: Of 1,021,177 emergency department encounters, OHCA visits had a higher BSI incidence than non-OHCA visits (413/3,429, 12.0% vs. 7,429/242,302, 3.1%; P<0.001). Compared with the matched non-OHCA (2,478) patients, OHCA (413) patients experienced more bacteremic episodes due to lower respiratory tract infections, fewer urosepsis events, fewer Escherichia coli bacteremia, and more streptococcal and anaerobes bacteremia. More antimicrobial-resistant organisms, such as methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing Enterobacteriaceae, were evident in OHCA patients. Notably, each hour delay in AAT administration was associated with an average increase of 0.8% in crude 30-day mortality rates (adjusted odds ratio [AOR], 1.008; P = 0.04) in OHCA patients, 7% (AOR, 1.007; P < 0.001) in critically ill patients without OHCA, and 3% (AOR, 1.003; P < 0.001) in less critically ill patients.
Conclusions: BSIs should be considered in patients experiencing OHCA; bacteremia sources, causative microorganisms, and antimicrobial susceptibilities differed between the OHCA and non-OHCA patients. The incorporation of blood culture samplings and rapid initiation of broad-spectrum antimicrobial therapy as the first-aids is essential for OHCA patients.
Keywords
bacteremia, out-of-hospital cardiac arrest, empirical antibiotic
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Research
Blood Cultures and Broad-Spectrum Antimicrobials are Essential for Patients with Out-of-Hospital Cardiac Arrest
Ching-Chi Lee
National Cheng Kung University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-4949-2742
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 28 Sep, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Etiologies of out-of-hospital cardiac arrest (OHCA) have been majorly focused on cardiac origins. Little is known regarding the role of bloodstream infections (BSIs) in OHCA episodes. Our aim was to disclose clinical features and incidences of BSIs and the survival benefit of prompt administration of appropriate antimicrobial therapy (AAT) in adults with OHCA.
Methods: In the 10-year multicenter cohort, clinical information was retrospectively collected and causative microorganisms were prospectively stored for species identification and susceptibilities. The effect of delayed AAT administration on 30-day mortality was examined after adjustment for independent predictors of mortality, recognized by a multivariate regression analysis.
Results: Of 1,021,177 emergency department encounters, OHCA visits had a higher BSI incidence than non-OHCA visits (413/3,429, 12.0% vs. 7,429/242,302, 3.1%; P<0.001). Compared with the matched non-OHCA (2,478) patients, OHCA (413) patients experienced more bacteremic episodes due to lower respiratory tract infections, fewer urosepsis events, fewer Escherichia coli bacteremia, and more streptococcal and anaerobes bacteremia. More antimicrobial-resistant organisms, such as methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing Enterobacteriaceae, were evident in OHCA patients. Notably, each hour delay in AAT administration was associated with an average increase of 0.8% in crude 30-day mortality rates (adjusted odds ratio [AOR], 1.008; P = 0.04) in OHCA patients, 7% (AOR, 1.007; P < 0.001) in critically ill patients without OHCA, and 3% (AOR, 1.003; P < 0.001) in less critically ill patients.
Conclusions: BSIs should be considered in patients experiencing OHCA; bacteremia sources, causative microorganisms, and antimicrobial susceptibilities differed between the OHCA and non-OHCA patients. The incorporation of blood culture samplings and rapid initiation of broad-spectrum antimicrobial therapy as the first-aids is essential for OHCA patients.
Figure 1
Figure 2
Figure 3
Figure 4