Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2023.07.011
Brazilian Journal of Anesthesiology
Original Investigation

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

Associação do uso de antimicrobianos e incidência de pneumonia hospitalar em pacientes graves traumatizados com contusão pulmonar: um estudo observacional

Estevão Bassi, Camila Trevizani Merighi, Carlos Issamu Tomizuka, Thais Guimarães, Fernando da Costa Ferreira Novo, Sergio Henrique Bastos Damous, Edivaldo Massazo Utiyama, Luiz Marcelo Sá Malbouisson

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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 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). 

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.

Keywords

Thoracic injuries; Lung injury; Healthcare-associated pneumonia; Antibacterial agents

Resumo

Introdução

A pneumonia ocorre em cerca de 20% dos pacientes traumatizados com contusões pulmonares. Este estudo tem como objetivo avaliar a associação entre antibioticoterapia empírica e pneumonia nosocomial nesta população.

Métodos

Coorte retrospectiva de pacientes adultos internados em UTI traumato-cirúrgica. O Grupo Antibiótico (GAT) foi definido pelo uso de antibiótico intravenoso por mais de 48 horas a partir da admissão hospitalar, enquanto o Grupo Conservador (GC) foi determinado pelo uso de antibióticos por período não superior a 48 horas. O desfecho primário foi pneumonia nosocomial documentada microbiologicamente dentro de 14 dias após a admissão hospitalar. A regressão logística foi utilizada para estimar a associação entre a alocação do grupo e o desfecho primário. Foram realizadas análises exploratórias avaliando a associação entre cepas resistentes na pneumonia e uso de antibióticos.

Resultados

O estudo incluiu 177 pacientes com trauma torácico e contusão pulmonar na tomografia computadorizada. O GAT estava mais gravemente doente do que o GC, conforme demonstrado pelo maior Injury Severity Score, SAPS3, pontuação SOFA, taxas mais altas e maior duração da ventilação mecânica. Na análise multivariada, o GAT foi associado a uma menor incidência de desfecho primário (OR = 0,25, IC 95% 0,09–0,64; p < 0,01). Resultados semelhantes foram encontrados na análise de sensibilidade com outro conjunto de variáveis. No entanto, cada dia de uso de antibióticos foi associado a um risco aumentado de pneumonia por bactérias resistentes (OR = 1,18 por dia, IC 95% 1,05–1,36; p < 0,01).

Conclusão

A antibioticoterapia empírica foi independentemente associada à menor incidência de pneumonia nosocomial em pacientes críticos com contusão pulmonar. No entanto, cada dia de uso de antibióticos foi associado ao aumento de cepas resistentes em pacientes infectados.

Palavras-chave

Lesões torácicas; Lesão pulmonar; Pneumonia associada aos cuidados de saúde; Agentes antibacterianos

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Submitted date:
12/01/2022

Accepted date:
07/21/2023

64efb76da9539564d30e2cd5 rba Articles
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