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Lower respiratory tract infections following cardiac arrest and cardiopulmonary resuscitation
Abstract:
All episodes of lower respiratory tract infection that developed among 96 patients surviving for > 24 hours after cardiac arrest were prospectively studied over an 18-month period. Pneumonia developed in 23 (24.0%) of patients after a mean of 7 days (SD, +/- 6.2 days). The development of four superinfections raised the cumulative incidence to 28.1%. Purulent tracheobronchitis was diagnosed in three instances. The causative agent of pneumonia was identified in 18 episodes, three of which were polymicrobial. Gram-positive cocci represented 57.1% of isolates, and Staphylococcus aureus--the most frequently isolated microorganism in this population--accounted for two-thirds of all gram-positive cocci. Pseudomonas aeruginosa was isolated in six episodes, five of which were associated with previous antibiotic use. Nine (39.1%) of the 23 patients in the group with pneumonia died, but only one of these deaths was considered to be directly related to pneumonia. In conclusion, pneumonia is a common complication of patients surviving cardiac arrest, but, with adequate treatment, its influence on outcome is marginal. Gram-positive cocci are the predominant pathogens, although infection with P. aeruginosa should be considered among patients receiving antibiotics.
Insights
Pneumonia is a frequent complication for cardiac arrest survivors, affecting 24% of patients. While common, this lower respiratory tract infection has a minimal impact on patient outcomes with appropriate treatment.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Patients surviving cardiac arrest are at risk for secondary infections.
- Lower respiratory tract infections (LRTIs) are a significant concern in this vulnerable population.
Purpose of the Study:
- To prospectively investigate the incidence and characteristics of pneumonia in patients surviving cardiac arrest.
- To identify common pathogens and their association with clinical factors and outcomes.
Main Methods:
- Prospective study of 96 patients surviving >24 hours after cardiac arrest over 18 months.
- Monitoring for and diagnosis of lower respiratory tract infections, including pneumonia and purulent tracheobronchitis.
- Microbiological analysis to identify causative agents of pneumonia.
Main Results:
- Pneumonia developed in 23% of patients, with a cumulative incidence of 28.1% including superinfections.
- Gram-positive cocci, particularly Staphylococcus aureus, were the most common pathogens.
- Pseudomonas aeruginosa was frequently isolated in patients with prior antibiotic use.
- Mortality was higher in the pneumonia group (39.1%), but pneumonia was directly linked to only one death.
Conclusions:
- Pneumonia is a common complication in cardiac arrest survivors but has a marginal impact on mortality with adequate treatment.
- Gram-positive cocci are the predominant pathogens.
- Consider Pseudomonas aeruginosa in patients with a history of antibiotic use.