Katelyn Jimison, PharmD,
PGY2 Critical Care Pharmacy Resident
Vidant Medical Center
Greenville, North Carolina
Disclosure information not submitted.
Tyler Chanas, BCCCP, PharmD
Critical Care Clinical Pharmacist
Vidant Medical Center
Greenville, North Carolina
Disclosure information not submitted.
Title: Evaluation of cultures and antibiotic use following cardiac arrest
Introduction: Infections may be common following cardiac arrest, but data are limited to guide antibiotic therapy. Current guidelines for management of post-cardiac arrest care recommend against prophylactic antibiotics in patients after ROSC, although antibiotics are often given for suspected infection. The purpose of this study was to characterize the incidence of positive cultures, common organisms identified on culture, and use of empiric antibiotics following cardiac arrest.
Methods: This retrospective, single-center analysis included adult patients with documented ROSC after in-hospital or out-of-hospital cardiac arrest admitted to an intensive care unit between January 2018 and December 2019. Patients with known infection receiving antibiotics prior to cardiac arrest were excluded. The primary endpoint was incidence of positive cultures following cardiac arrest. Secondary outcomes included empiric antibiotics administered within 7 days of cardiac arrest and organisms identified on culture.
Results: A total of 758 patients were screened and 625 patients were included for analysis. One or more positive cultures were observed in 193 (31%) of patients within 7 days following cardiac arrest. Incidence of positive cultures was not significantly different between patients with in-hospital versus out-of-hospital arrest (P=0.13). The most common bacteria identified on culture were Gram-negative organisms. MRSA and Pseudomonas were isolated in cultures from only 2% and 5% of patients, respectively. Most patients (57%) received one or more antibiotics within 7 days following arrest. The most commonly administered antibiotics were piperacillin-tazobactam (38%) and vancomycin (29%).
Conclusions: Positive cultures occurred in about one-third of patients, and did not appear to be impacted by location of cardiac arrest. Despite this, a large portion of these patients received antibiotics, often with broad spectrum agents including MRSA and Pseudomonas coverage. The low incidence of resistant organisms so often targeted with antimicrobial therapy in this patient population presents an opportunity for selection of more narrow antimicrobial regimens in patients with concern for true infection following cardiac arrest.