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Empiric antimicrobial therapy for early-onset pneumonia in severe trauma patients

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The bacterial ecology involved in early pneumonia of severe trauma patients is mostly commensal and would allow wide use of narrow-spectrum antibiotics. We describe risk factors for treatment failure of severe trauma patients’ pneumonia with the use of narrow-spectrum antimicrobial therapy in order to develop a score that could help clinicians to determine which patients might be treated with narrow-spectrum antibiotics.

Methods

A retrospective, observational, monocentric cohort study was conducted of severe trauma patients requiring mechanical ventilation for > 48 h and developing a first episode of microbiologically confirmed pneumonia occurring within the first 10 days after admission.

Results

Overall, 370 patients were included. The resistance rate against narrow-spectrum antibiotics (amoxicillin/clavulanic acid) was 22.7% (84 pneumonia). In a multivariate analysis, two independent risk factors were associated with this resistance: prior antimicrobial therapy ≥ 48 h (OR 4.00; 95 CI [2.39; 6.75]) and age ≥ 30y (OR 2.10; 95 CI [1.21; 3.78]). We created a prediction score that defined patient with one or two risk factors at high risk of resistance. This score presented a sensitivity of 0.92 [0.88; 0.94], a specificity of 0.33 [0.28; 0.38], a positive predictive value of 0.29 [0.24; 0.33] and a negative predictive value of 0.93 [0.90; 0.95].

Conclusion

Simple risk factors may help clinicians to identify severe trauma patients at high risk of pneumonia treatment failure with the use of narrow-spectrum antimicrobial therapy and, thus, use better tailored empiric therapy and limit the use of unnecessary broad-spectrum antimicrobial therapy.

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Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP Nord, Université de Paris, 100 Boulevard du Général Leclerc, 92110, Clichy, France

    Maël Gennequin, Jean-Denis Moyer, Tobias Gauss, Emmanuel Weiss & Arnaud Foucrier

  2. Département d’épidémiologie, Biostatistiques et Recherche Clinique, Hôpital Bichat, AP-HP Nord, Université de Paris, 75018, Paris, France

    Delphine Bachelet & Philippine Eloy

  3. Intensive Care Unit, Anaesthesia and Critical Care Dept, Hôtel Dieu-HME, University Hospital of Nantes, Nantes, France

    Antoine Roquilly

Authors
  1. Maël Gennequin
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  2. Delphine Bachelet
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  3. Philippine Eloy
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  4. Jean-Denis Moyer
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  5. Antoine Roquilly
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  6. Tobias Gauss
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  7. Emmanuel Weiss
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  8. Arnaud Foucrier
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Contributions

MG conceptualization/methodology, analysis/statistics-software, data interpretation, writing original draft, approval original draft. DB conceptualization/methodology, analysis/statistics-software, data acquisition/curation, approval original draft. PE conceptualization/methodology, analysis/statistics-software, data acquisition/curation, approval original draft. JDM conceptualization/methodology, data interpretation, approval original draft. AR conceptualization/methodology, data interpretation, approval original draft. TG conceptualization/methodology, data interpretation, approval original draft. AF conceptualization/methodology, analysis/statistics-software, data acquisition/curation, data interpretation, writing original draft, approval original draft.

Corresponding author

Correspondence to Maël Gennequin.

Ethics declarations

Conflict of interest

Maël Gennequin, Delphine Bachelet, Philippine Eloy, Jean Denis Moyer, Antoine Roquilly, Tobias Gauss and Arnaud Foucrier had no conflicts of interest to declare.

Ethics approval

The study received ethical approval from the institutional review board (IRB 00006477) of the Paris Nord University. The data file was declared to the French Data Protection Agency (CNIL, No 911461).

Consent to participate and for publication

No consent is required. All patients were informed about the collection of medical data, by means of displays located at the entrance to the ward and in each inpatient room.

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Gennequin, M., Bachelet, D., Eloy, P. et al. Empiric antimicrobial therapy for early-onset pneumonia in severe trauma patients. Eur J Trauma Emerg Surg 48, 2763–2771 (2022). https://doi.org/10.1007/s00068-021-01870-2

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  • DOI: https://doi.org/10.1007/s00068-021-01870-2

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