在非医院心脏骤停后预防昏迷患者的早期肺炎:试点随机对照试验和抗体评估 (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
概括
在非医院心脏病停止 (OHCA) 后的预防性 ceftriaxone 可能会减少早期肺炎和抗生素耐药性基因的获取. 然而,该试验对其对肺炎发病率的整体影响是不确定的.
科学领域:
- 危急护理医学
- 传染性疾病
- 临床药理学
背景情况:
- 在非医院心脏骤停 (OHCA) 中使用抗生素预防可能会预防早期的肺炎.
- 有关对死亡率,非传染性结果和抗生素耐药性的影响存在担忧.
- 在OHCA幸存者中预防性抗生素的有效性和安全性需要进一步研究.
研究的目的:
- 评估预防性 ceftriaxone 是否可以减少 OHCA 幸存者的早期肺炎 (EOP).
- 为了确定 ceftriaxone 预防是否会增加抗生素耐药性基因 (ARG).
- 评估 ceftriaxone 对随后使用抗生素的必要性的影响.
主要方法:
- 接受针对性温度控制的昏迷OHCA幸存者被随机分为 ceftriaxone或安慰剂三天.
- 主要结局是输管后4天内诊断出EOP.
- 在治疗前和治疗后使用直肠拭片的基因测序来评估抗生素耐药性基因丰度.
主要成果:
- 早期出现的肺炎发生在38%的 ceftriaxone 组和69%的安慰剂组中 (RR 0. 57).
- 接受开放标签抗生素的人数较少 (54%与85%相比).
- 与安慰剂患者相比,接受塞夫特里亚的人获得的ARG显著减少 (IRR为0. 30).
结论:
- 在OHCA后,该试验对 ceftriaxone对降低EOP发病率的确切影响是不确定的.
- 塞夫特里亚克森预防与开放式抗生素的使用减少有关.
- 预防性 ceftriaxone 显示了与 ICU 抗生素相关的 ARG 的减少.
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