{"id":17920,"date":"2019-12-08T05:03:59","date_gmt":"2019-12-07T21:03:59","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17920"},"modified":"2019-12-12T07:10:02","modified_gmt":"2019-12-11T23:10:02","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%bf%83%e8%b7%b3%e9%aa%a4%e5%81%9c%e5%90%8e%e9%a2%84%e9%98%b2%e6%97%a9%e6%9c%9f%e5%91%bc%e5%90%b8%e6%9c%ba%e7%9b%b8%e5%85%b3%e8%82%ba%e7%82%8e","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17920","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u5fc3\u8df3\u9aa4\u505c\u540e\u9884\u9632\u65e9\u671f\u547c\u5438\u673a\u76f8\u5173\u80ba\u708e"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest<\/h1>\n\n\n\n

Bruno Fran\u00e7ois, Alain Cariou, Rapha\u00ebl Clere-Jehl, et al<\/h3>\n\n\n\n

N Engl J Med 2019; 381:1831-1842
DOI: 10.1056\/NEJMoa1812379<\/h3>\n\n\n\n

BACKGROUND \u80cc\u666f<\/h2>\n\n\n\n

Patients who are treated with targeted temperature management after out-of-hospital cardiac arrest with shockable rhythm are at increased risk for ventilator-associated pneumonia. The benefit of preventive short-term antibiotic therapy has not been shown.<\/p>\n\n\n\n

\u56e0\u53ef\u9664\u98a4\u5fc3\u5f8b\u5bfc\u81f4\u9662\u5916\u5fc3\u8df3\u9aa4\u505c\u4e14\u63a5\u53d7\u76ee\u6807\u6027\u4f53\u6e29\u7ba1\u7406\u7684\u60a3\u8005\u53d1\u751f\u547c\u5438\u673a\u76f8\u5173\u80ba\u708e\u7684\u98ce\u9669\u589e\u52a0\u3002\u77ed\u671f\u9884\u9632\u6027\u6297\u751f\u7d20\u7684\u76ca\u5904\u5c1a\u4e0d\u660e\u786e\u3002<\/p>\n\n\n\n

METHODS \u65b9\u6cd5<\/h2>\n\n\n\n

We conducted a multicenter, double-blind, randomized, placebo-controlled trial involving adult patients (>18 years of age) in intensive care units (ICUs) who were being mechanically ventilated after out-of-hospital cardiac arrest related to initial shockable rhythm and treated with targeted temperature management at 32 to 34\u00b0C. Patients with ongoing antibiotic therapy, chronic colonization with multidrug-resistant bacteria, or moribund status were excluded. Either intravenous amoxicillin\u2013clavulanate (at doses of 1 g and 200 mg, respectively) or placebo was administered three times a day for 2 days, starting less than 6 hours after the cardiac arrest. The primary outcome was early ventilator-associated pneumonia (during the first 7 days of hospitalization). An independent adjudication committee determined diagnoses of ventilator-associated pneumonia.<\/p>\n\n\n\n

\u6211\u4eec\u8fdb\u884c\u4e86\u4e00\u9879\u591a\u4e2d\u5fc3\u3001\u53cc\u76f2\u3001\u968f\u673a\u3001\u5b89\u6170\u5242\u5bf9\u7167\u8bd5\u9a8c\uff0c\u5165\u9009\u56e0\u53ef\u9664\u98a4\u5fc3\u5f8b\u5bfc\u81f4\u9662\u5916\u5fc3\u8df3\u9aa4\u505c\u7684\u6210\u5e74 (>18 \u5c81)\u60a3\u8005\uff0c\u6536\u5165ICU\uff0c\u63a5\u53d7\u76ee\u6807\u4f53\u6e29(32 to 34\u00b0C)\u7ba1\u7406\u4e14\u5e94\u7528\u673a\u68b0\u901a\u6c14\u3002\u5df2\u63a5\u53d7\u6297\u751f\u7d20\u6cbb\u7597\u3001\u591a\u91cd\u8010\u836f\u83cc\u957f\u671f\u5b9a\u690d\u6216\u4e34\u7ec8\u72b6\u6001\u60a3\u8005\u6392\u9664\u3002\u5728\u5fc3\u8df3\u9aa4\u505c\u540e6\u5c0f\u65f6\u5185\uff0c\u60a3\u8005\u5206\u522b\u63a5\u53d7\u9759\u8109\u963f\u83ab\u897f\u6797-\u514b\u62c9\u7ef4\u9178(\u5242\u91cf\u5206\u522b\u4e3a1 g \u548c 200 mg)\u6216\u5b89\u6170\u5242\uff0c\u6bcf\u65e53\u6b21\uff0c\u7597\u7a0b2\u5929\u3002\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a\u65e9\u671f\u547c\u5438\u673a\u76f8\u5173\u6027\u80ba\u708e(\u5728\u4f4f\u9662\u6700\u521d7\u5929\u5185\u53d1\u751f)\u3002\u7531\u4e00\u4e2a\u72ec\u7acb\u7684\u8bc4\u4f30\u59d4\u5458\u4f1a\u786e\u5b9a\u547c\u5438\u673a\u76f8\u5173\u6027\u80ba\u708e\u7684\u8bca\u65ad\u3002<\/p>\n\n\n\n

RESULTS \u7ed3\u679c<\/h2>\n\n\n\n

A total of 198 patients underwent randomization, and 194 were included in the analysis. After adjudication, 60 cases of ventilator-associated pneumonia were confirmed, including 51 of early ventilator-associated pneumonia. The incidence of early ventilator-associated pneumonia was lower with antibiotic prophylaxis than with placebo (19 patients [19%] vs. 32 [34%]; hazard ratio, 0.53; 95% confidence interval, 0.31 to 0.92; P=0.03). No significant differences between the antibiotic group and the control group were observed with respect to the incidence of late ventilator-associated pneumonia (4% and 5%, respectively), the number of ventilator-free days (21 days and 19 days), ICU length of stay (5 days and 8 days if patients were discharged and 7 days and 7 days if patients had died), and mortality at day 28 (41% and 37%). At day 7, no increase in resistant bacteria was identified. Serious adverse events did not differ significantly between the two groups.<\/p>\n\n\n\n

\u5171\u6709198\u540d\u60a3\u8005\u63a5\u53d7\u968f\u673a\u5206\u7ec4\uff0c194\u540d\u60a3\u8005\u7eb3\u5165\u5206\u6790\u3002\u7ecf\u8fc7\u5224\u65ad\uff0c\u5171\u786e\u8bca60\u540d\u547c\u5438\u673a\u76f8\u5173\u6027\u80ba\u708e\u60a3\u8005\uff0c\u5305\u62ec51\u4f8b\u65e9\u671f\u547c\u5438\u673a\u76f8\u5173\u80ba\u708e\u3002\u4e0e\u5b89\u6170\u5242\u76f8\u6bd4\uff0c\u6297\u751f\u7d20\u9884\u9632\u7ec4\u65e9\u671f\u547c\u5438\u673a\u76f8\u5173\u80ba\u708e\u53d1\u751f\u7387\u8f83\u4f4e(19 [19%] vs. 32 [34%]; \u98ce\u9669\u6bd4, 0.53; 95% \u53ef\u4fe1\u533a\u95f4, 0.31 to 0.92; P=0.03)\u3002\u6297\u751f\u7d20\u7ec4\u4e0e\u5bf9\u7167\u7ec4\u665a\u671f\u547c\u5438\u673a\u76f8\u5173\u80ba\u708e\u53d1\u751f\u7387(4% vs. 5%)\uff0c\u65e0\u673a\u68b0\u901a\u6c14\u5929\u6570 (21 vs. 19 \u5929)\uff0cICU\u4f4f\u9662\u65e5 (\u5b58\u6d3b\u60a3\u8005 5 vs. 8 \u5929\uff0c\u6b7b\u4ea1\u60a3\u8005 7 vs. 7 \u5929)\uff0c\u53ca28\u5929\u75c5\u6b7b\u7387 (41% vs. 37%)\u5e76\u65e0\u5dee\u5f02\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

CONCLUSIONS \u7ed3\u8bba<\/h2>\n\n\n\n

A 2-day course of antibiotic therapy with amoxicillin\u2013clavulanate in patients receiving a 32-to-34\u00b0C targeted temperature management strategy after out-of-hospital cardiac arrest with initial shockable rhythm resulted in a lower incidence of early ventilator-associated pneumonia than placebo. No significant between-group differences were observed for other key clinical variables, such as ventilator-free days and mortality at day 28.<\/p>\n\n\n\n

\u5bf9\u4e8e\u56e0\u53ef\u9664\u98a4\u5fc3\u5f8b\u5bfc\u81f4\u9662\u5916\u5fc3\u8df3\u9aa4\u505c\u4e14\u63a5\u53d7\u76ee\u6807\u4f53\u6e29(32 to 34\u00b0C)\u7ba1\u7406\u7684\u60a3\u8005\uff0c\u6536\u5165ICU\uff0c\u4e0e\u5b89\u6170\u5242\u76f8\u6bd4\uff0c2\u5929\u7597\u7a0b\u7684\u963f\u83ab\u897f\u6797-\u514b\u62c9\u7ef4\u9178\u80fd\u591f\u80fd\u591f\u964d\u4f4e\u65e9\u671f\u547c\u5438\u673a\u76f8\u5173\u80ba\u708e\u7684\u53d1\u751f\u7387\u3002\u5176\u4ed6\u4e3b\u8981\u4e34\u5e8a\u6307\u6807\u5982\u65e0\u673a\u68b0\u901a\u6c14\u5929\u6570\u53ca28\u5929\u75c5\u6b7b\u7387\u4e24\u7ec4\u95f4\u65e0\u663e\u8457\u5dee\u5f02\u3002<\/p>\n\n\n\n

(Funded by the French Ministry of Health; ANTHARTIC ClinicalTrials.gov number,\u00a0NCT02186951. opens in new tab<\/a>.)<\/p>\n\n\n\n

\u8bc4\u8bba[\u4ec5\u4ee3\u8868\u4e2a\u4eba\u89c2\u70b9]<\/h2>\n\n\n\n
  • \u8001\u8c03\u91cd\u5f39\uff1a\u591a\u79cd\u975e\u624b\u672f\u60c5\u51b5\u4e0b\u7684\u9884\u9632\u6027\u6297\u751f\u7d20\u662f\u5f88\u4e45\u4ee5\u6765\u4e34\u5e8a\u7814\u7a76\u7684\u8bdd\u9898\uff0c\u5982\u591a\u53d1\u521b\u4f24\u60a3\u8005\u533b\u9662\u83b7\u5f97\u6027\u80ba\u708e\u7684\u9884\u9632\uff0c\u514d\u75ab\u529f\u80fd\u6291\u5236\u60a3\u8005PCP\u7684\u9884\u9632\u7b49\uff0c\u6c89\u5bc2\u4e00\u6bb5\u65f6\u95f4\u540e\u53c8\u51fa\u73b0\u4e86\u65b0\u7684\u7814\u7a76\u7ed3\u679c<\/li>
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    ORIGINAL ARTICLE Prevention of Early Ventilator-Associa […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17920"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17920"}],"version-history":[{"count":4,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17920\/revisions"}],"predecessor-version":[{"id":17999,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17920\/revisions\/17999"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17920"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17920"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17920"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}