Association of antimicrobial use and incidence of hospital-acquired pneumonia in critically ill trauma patients with pulmonary contusion: an observational study

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. Retrospective cohort of adult patients admitted to a trauma-surgical ICU. The Antibiotic Therapy G...

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Bibliographic Details
Published in:	Brazilian journal of anesthesiology (Elsevier) Vol. 74; no. 3; p. 744454
Main Authors:	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
Format:	Journal Article
Language:	English
Published:	Brazil Elsevier España S.L.U 01-05-2024 Elsevier
Subjects:	Adult Aged Anti-Bacterial Agents - administration & dosage Antibacterial agents Cohort Studies Contusions - epidemiology Critical Illness Female Healthcare-associated pneumonia Healthcare-Associated Pneumonia - drug therapy Healthcare-Associated Pneumonia - epidemiology Humans Incidence Lung injury Lung Injury - epidemiology Male Middle Aged Original Investigation Retrospective Studies Thoracic injuries Thoracic injuries Antibacterial agents Healthcare-associated pneumonia Lung injury
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Summary:	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. 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. The study included 177 patients with chest trauma and pulmonary contusion on CT scan. 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). 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.
ISSN:	0104-0014 0104-0014 2352-2291
DOI:	10.1016/j.bjane.2023.07.011