Prophylactic Antimicrobial Therapy for Acute Aspiration Pneumonitis.
Clin Infect Dis. 2018 Feb 09;:
Authors: Dragan V, Wei L, Elligsen M, Kiss A, Walker SAN, Leis JA
Background: Prophylactic antimicrobial therapy is frequently prescribed for acute aspiration pneumonitis following macro-aspiration with the intent of preventing the development of aspiration pneumonia; however, few clinical studies have examined the benefits and harms of this practice.
Methods: A retrospective cohort study design was used to assess outcomes of patients receiving antimicrobial prophylaxis with those receiving supportive care only during the initial two days following an acute aspiration pneumonitis episode. The primary outcome was in-hospital mortality within 30-days. Secondary outcomes included transfer to critical care, and antimicrobial therapy received including escalation of therapy and antibiotic-free days between days 3 to 14 following the acute aspiration event.
Results: Among 1483 patients reviewed, 200 met the case definition for acute aspiration pneumonitis including 76 (38%) who received prophylactic antimicrobial therapy and 124 (62%) receiving supportive management only. Unadjusted in-hospital mortality was similar between both groups (25%; 95% CI, 17-36% vs. 25%; 95% CI, 18-33%; p=1). Patients receiving antimicrobial prophylaxis were no less likely to require transfer to critical care (5% vs. 6%; p=.7) and subsequently received more frequent escalation of antibiotic therapy (8% vs. 1%; p=.002) and fewer antibiotic-free days (7.5 vs. 10.9; p <.0001). After adjusting for patient-level predictors, antimicrobial prophylaxis was not associated with any improvement in mortality (OR 0.9; 95% CI, 0.4-1.7; p=0.7).
Conclusions: Prophylactic antimicrobial therapy for patients with acute aspiration pneumonitis does not offer clinical benefit and may generate antibiotic selective pressures that result in the need for escalation of antibiotic therapy among those who develop aspiration pneumonia.
PMID: 29438467 [PubMed - as supplied by publisher]