{"id":29955,"date":"2026-03-11T04:08:00","date_gmt":"2026-03-10T20:08:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29955"},"modified":"2026-03-11T05:54:42","modified_gmt":"2026-03-10T21:54:42","slug":"chest%e5%8f%91%e8%a1%a8%e8%bf%b0%e8%af%84%ef%bc%9a%e9%a2%84%e9%98%b2%e9%99%a2%e5%a4%96%e5%bf%83%e8%b7%b3%e9%aa%a4%e5%81%9c%e5%90%8e%e6%97%a9%e5%8f%91%e8%82%ba%e7%82%8e%e7%9a%84%e6%9c%89%e5%b8%8c","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29955","title":{"rendered":"[Chest\u53d1\u8868\u8ff0\u8bc4]\uff1a\u9884\u9632\u9662\u5916\u5fc3\u8df3\u9aa4\u505c\u540e\u65e9\u53d1\u80ba\u708e\u7684\u6709\u5e0c\u671b\u7684\u7ebf\u7d22"},"content":{"rendered":"\n

EDITORIAL<\/strong><\/p>\n\n\n\n

Promising Leads in Preventing Early-Onset Pneumonia After Out-Of-Hospital Cardiac Arrest<\/h1>\n\n\n\n

St\u00e9phane Legriel<\/h3>\n\n\n\n

Chest 2025; 169: 3-5<\/h3>\n\n\n\n

DOI: 10.1016\/j.chest.2025.09.123<\/a><\/h3>\n\n\n\n

Initial hospital treatment of patients in post-anoxic coma relies on a multifaceted approach. This encompasses the identification and treatment of the underlying cause(s) of cardiac arrest, with a focus on prevention of its reoccurrence, a consideration of post-resuscitation syndrome, the implementation of neuroprotective measures (including targeted temperature management), and the preparation for the subsequent neuroprognostication phase.1<\/sup><\/a> The occurrence of early-onset pneumonia (EOP) after cardiac arrest is a complication inherent to the resuscitation phase, identified in 65% of cases.2<\/sup><\/a> The diagnosis of this condition is challenging. First, the distinction between aseptic chemical pneumonitis (or aspiration pneumonitis) and aspiration pneumonia is subtle. Aspiration pneumonitis is defined by inhalation of gastric contents and may be associated with a noninfectious inflammatory reaction. Aspiration pneumonia is an infection that results from the inoculation of bacteria into the lungs; its diagnosis is based on solid diagnostic criteria combining an inhalation mechanism that is evident in the context of cardiac arrest, signs of acute lower respiratory infection, and a new radiologic infiltrate.3<\/sup><\/a> To date, no biomarkers have been identified that facilitate its identification, and microbiologic testing is not essential to confirm the diagnosis.3-5<\/sup><\/a> Furthermore, targeted temperature management, especially when used with a low temperature target, such as in mild hypothermia, can not only mask fever (which would otherwise raise suspicion of inhalation pneumonia), but also can promote its onset.6<\/sup><\/a><\/p>\n\n\n\n

Research groups have proposed a prophylactic strategy that involves early administration of antibiotic therapy. First, within the context of a randomized controlled trial (RCT) that includes patients in coma subsequent to acute brain injury, the administration of ceftriaxone 2 g as compared with placebo once, within 12 hours after tracheal intubation, was found to be associated with a reduced prevalence of ventilator-associated pneumonia between day 2 and day 7 after acute brain injury (14% [n = 23 of 162] vs 32% [n = 51 of 157]; hazard ratio [HR], 0.6 [95% CI, 0.38 to 0.95]; P<\/em> = .03). This strategy was not associated with microbiologic impact, nor was it related to significant adverse effects.7<\/sup><\/a> Second, another RCT examined this approach in patients with cardiac arrest and an initial shockable rhythm. The trial compared the administration of 1 g\/200 mg of IV amoxicillin\u2013clavulanate 3 times a day for 2 days with a placebo to reduce ventilator-associated pneumonia within 7 days of cardiac arrest. The authors reported an early ventilator-associated pneumonia rate of 19% (n = 19 of 99) in the prophylaxis group vs 34% (n = 32 of 95) in the placebo group (HR, 0.53; 95% CI, 0.31 to 0.92; P<\/em> = .03).8<\/sup><\/a><\/p>\n\n\n\n

In this issue of CHEST<\/em>, Gagnon et al9<\/sup><\/a> used a RCT study design with a 1:1 ratio to focus on the overall population of patients in post-anoxic coma after out-of-hospital cardiac arrest (OHCA) and receiving targeted temperature management between 33 \u00b0C and 36 \u00b0C.9<\/sup><\/a> Patients were included in the study and randomly assigned to receive IV ceftriaxone 2 g every 12 hours for 3 days or placebo within a maximum time frame of 6 hours from ICU admission to drug administration. Patients with suspected or documented infection were deemed ineligible. The primary objective was to assess the effectiveness of prophylactic antibiotic therapy in decreasing the occurrence of EOP. With a power of 80% and a 2-tailed alpha risk of 5%, a total of 120 patients were required to demonstrate an absolute decrease in prevalence of 25% (55% in the placebo group to 30% in the antibiotic therapy group). The primary end point was defined as EOP, which was characterized by the presence of new or progressive focal lung consolidation prior to the day 5 after cardiac arrest and by a combination of clinical symptoms that varied according to the time of critical care management during or after targeted temperature management. The presence or absence of EOP was to be determined by an adjudication committee. Only 53 patients could be included, of whom 52 of whom the condition was analyzable; 26 were receiving ceftriaxone, and 26 were receiving placebo. The prevalence of EOP was 38% in patients who were receiving ceftriaxone vs 69% in those receiving placebo: (risk ratio, 0.57; 0.95% CI, 0.21 to 1.001; P<\/em> = .05) and (risk ratio, 0.37; 0.95% CI, 0.12 to 1.08; P<\/em> = .09) before and after adjusted adjudicator-confirmed EOP, respectively. Prespecified safety outcomes and acquisition of antibiotic resistance genes were similar in both treatment groups.<\/p>\n\n\n\n

The authors conducted 1 of the few studies to focus on preventing EOP after cardiac arrest. While the study of Fran\u00e7ois et al8<\/sup><\/a>focused on a comparable strategy and included ventilator-associated pneumonia at occurred up to 7 days after cardiac arrest, the authors\u2019 study was the only 1 to focus on EOP, defined as pneumonia occurring within 4 days after cardiac arrest. The study has good internal validity, combining technical characteristics that are appropriate for a superiority RCT. These include centralized block randomization, standardization of care according to the latest international guidelines, and an intention-to-treat analysis. The authors used a clear definition of EOP after cardiac arrest and an adjudication committee to determine the primary end point. Including patients with OHCA is consistent with the prophylactic antibiotic therapy strategy with the use of ceftriaxone, and the range of bacteria identified in sputum samples confirms the relevance of this choice. Finally, the characteristics of the included population are comparable with those of patients presenting with OHCA, particularly regarding the Utstein criteria, except for the moderately high proportion of patients with an initial non-shockable heart rhythm.10<\/sup><\/a> This ensures relatively satisfactory external validity overall.<\/p>\n\n\n\n

Despite a nonsignificant decrease in the prevalence of EOP, the use of ceftriaxone rather than amoxicillin-clavulanate appears to be associated with a low rate of acquired antibiotic resistance genes. The other secondary end points also offer interesting avenues for future studies, particularly the association of ceftriaxone with a lower mortality rate, and a greater number of ICU-free and mechanical ventilator-free days up to day 28.<\/p>\n\n\n\n

However, despite these important advances, several points remain questionable. The main one is related to the early termination of inclusions, which did not allow for the expected number of participants to be included. The study is therefore clearly underpowered, and the results of the primary end point should be interpreted with caution. Another important point for discussion is the high proportion of patients who received targeted temperature management with mild hypothermia at 33 \u00b0C. This is a practice that has been declining since the publication of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial, which reduces the applicability of the study findings.11<\/sup><\/a><\/p>\n\n\n\n

In conclusion, despite the limitations inherent in a clearly underpowered RCT, the results reported constitute encouraging preliminary data, indicating the potential efficacy of ceftriaxone in reducing the prevalence of EOP, with few or no side-effects. Other outcomes, such as mortality rates, warrant investigation in future RCTs.<\/p>\n","protected":false},"excerpt":{"rendered":"

EDITORIAL Promising Leads in Preventing Early-Onset Pne […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29955"}],"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=29955"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29955\/revisions"}],"predecessor-version":[{"id":29958,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29955\/revisions\/29958"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29955"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29955"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29955"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}