病院外での心停止後の昏睡状態の患者の早期発症性肺炎を予防するセフトリアキソン:試験的なランダム化対照試験とレジストーム評価 (PROTECT)
David J Gagnon1, Kristin M Burkholder2, Alexandra J Weissman3
1Department of Pharmacy, Maine Medical Center, Portland, ME 04102; MaineHealth Institute for Research, Scarborough, ME 04074; Tufts University School of Medicine, Boston, MA 02111.
Chest
|August 30, 2025
まとめ
病院外心停止後の予防的なセフトリアキソン (OHCA) は,早期発症の肺炎と抗生物質耐性遺伝子の獲得を減少させる可能性があります. しかし,この試験は肺炎の発生率に対する全体的な影響について決定的ではなかった.
科学分野:
- クリティカル ケア 医療
- 感染症
- 臨床薬理学
背景:
- 病院外心停止 (OHCA) の抗生物質予防は,早期発症の肺炎を予防することができます.
- 死亡率,非感染性アウトカム,抗生物質耐性の発達への影響については懸念があります.
- OHCAの生存者における予防抗生物質の有効性と安全性については,さらなる調査が必要である.
研究 の 目的:
- 予防的なセフトリアクソンが早期発症性肺炎 (EOP) を減少させるかどうかを評価する.
- セフトリアキソンによる予防が抗生物質耐性遺伝子 (ARG) の獲得を増加させるかどうかを判断する.
- 後に抗生物質投与の必要性に対するセフトリアキソンの影響を評価する.
主な方法:
- 3日間セフトリアキソンまたはプラセボにランダムに割り当てられました.
- 主なアウトカムは,挿管後4日以内にEOPが診断されたことでした.
- 抗生物質耐性遺伝子の豊富さは,治療前のおよび後の直腸スランプのメタゲノミクス配列を用いて評価されました.
主要な成果:
- 早期発症した肺炎はセフトリアキソン群の38%で,プラセボ群の69%で発生した (RR0. 57).
- セフトリアキソン群では,オープンラベル抗生物質を投与した患者が少ない (54% vs 85%).
- セフトリアキソンを受けた人はプラセボを受けた人と比較してARGが著しく少ない (IRR0. 30).
結論:
- この試験は,OHCA後のEOP発生率の減少に対するセフトリアキソンの決定的な影響について無結論であった.
- セフトリアキソン予防は,オープンラベルの抗生物質の使用量の減少と関連していました.
- 予防用セフトリアクソンは,ICUの抗生物質に関連するARGの獲得を減少させた.
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