CHU Rennes, Service de Réanimation Chirurgicale, Hôpital Pontchaillou, 2 rue Henri Le Guilloux, Rennes 35000, France.
Département d'Anesthésie Réanimation, CHU Nantes, 1 Place Alexis-Ricordeau, Nantes 44000, France.
J Crit Care. 2019 Apr;50:221-226. doi: 10.1016/j.jcrc.2018.12.010. Epub 2018 Dec 18.
To investigate the role of antibiotic prophylaxis (AP) in the incidence of ventilator-associated pneumonia (VAP) in patients suffering from traumatic brain injury (TBI).
This post hoc analysis was conducted based on data from 2 multicentre double-blind studies that aimed to prevent VAP using hydrocortisone or povidone iodine. Data from TBI patients were extracted and pooled. Patients were classified into 2 groups: those who received an AP (AP group) and those who did not (control group).
295 patients were included (AP group, n = 146; control group, n = 149). The incidence of VAP was 145 (49%). VAP incidence was lower in the AP group (39% vs 59%, Relative Risk = 0.33, 95%CI, 0.19-0.56, p = 0.001). Time to VAP occurrence was delayed (Hazard Ratio = 0.50, 95%CI 0.36-0.69, p < 0.001). The incidence of early VAP (>2 and ≤ 5 days) was lower in the AP group (10% vs 32%; p < 0.001), whereas that of late VAP (>5 days) did not differ (AP group 29% vs control group 28%; p = 0.811). Length of stay and mortality did not differ between the 2 groups.
Early use of AP delayed and may prevent the occurrence of VAP in severe TBI patients but did not change length of stay or mortality.
研究抗生素预防（AP）在创伤性脑损伤（TBI）患者呼吸机相关性肺炎（VAP）发病率中的作用。
本回顾性分析基于旨在使用氢化可的松或聚维酮碘预防 VAP 的 2 项多中心、双盲研究的数据进行。提取并汇总 TBI 患者的数据。患者分为 2 组：接受 AP（AP 组）和未接受 AP（对照组）。
共纳入 295 例患者（AP 组 146 例，对照组 149 例）。VAP 发生率为 145（49%）。AP 组 VAP 发生率较低（39%比 59%，相对风险为 0.33，95%CI，0.19-0.56，p=0.001）。VAP 发生时间延迟（风险比为 0.50，95%CI 0.36-0.69，p<0.001）。AP 组早期 VAP（>2 天且≤5 天）发生率较低（10%比 32%；p<0.001），而晚期 VAP（>5 天）发生率无差异（AP 组 29%比对照组 28%；p=0.811）。两组患者的住院时间和死亡率无差异。
早期使用 AP 可延迟并可能预防严重 TBI 患者发生 VAP，但不会改变住院时间或死亡率。
