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Infections in out-of-hospital and in-hospital post-cardiac arrest patients

Abstract

This study aims to describe infectious complications in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients with sustained return of spontaneous circulation (ROSC) and to compare differences in antimicrobial treatment and outcomes between the two groups. This was a retrospective, single-center, observational study. Adult patients (≥ 18 years) with OHCA or IHCA who had sustained ROSC between December 2007 to March 2015 were included. Blood, urine, sputum, and other fluid cultures, as well as radiologic imaging, were obtained at the discretion of the treating clinical teams. 275 IHCA and 318 OHCA patients were included in the analysis. We found evidence of infection in 181 IHCA and 168 OHCA patients. Significant differences were found between the IHCA and OHCA group in terms of initial rhythm, duration of arrest (10 min vs. 20, p = < 0.001), targeted temperature management (30% vs. 73%, p = < 0.001), and post-arrest infection rates (66% vs 53%, p = 0.001). 95% of IHCA and 82% of OHCA patients received antimicrobial treatment in the post-cardiac arrest period. The source of infection in both groups was largely respiratory, followed by urinary. Gram-positive cocci and gram-negative rods were the most common organisms identified among subjects with culture-proven bacteremia. Infections in the post-arrest period were common in both OHCA and IHCA. We found significantly more infections in IHCA compared to OHCA patients. The most common infection category was respiratory and the most common organism isolated from sputum cultures was Staphylococcus aureus coagulase-positive. The incidence of culture-positive bacteremia was similar in both OHCA and IHCA cohorts but overall lower than previously reported.

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Abbreviations

IHCA:

In-hospital cardiac arrest

OHCA:

Out-of-hospital cardiac arrest

ROSC:

Return of spontaneous circulation

PNA:

Pneumonia

UTI:

Urinary tract infection

TTM:

Targeted temperature management

Abx:

Antibiotics

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Author information

Correspondence to Sharri Junadi Mortensen.

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Conflict of interest

We, the authors, have nothing to disclose. No funding was received for this project and we have no conflict of interest.

Statement of human and animal rights

This study was approved by our hospital’s institutional review board.

Informed consent

This study was approved by the Institutional Board Review (IRB) at Beth Israel Deaconess Medical Center at Harvard Medical School. For this retrospective clinical study, the IRB did not require formal consent from individual patients.

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Cite this article

Mortensen, S.J., Hurley, M., Blewett, L. et al. Infections in out-of-hospital and in-hospital post-cardiac arrest patients. Intern Emerg Med (2020). https://doi.org/10.1007/s11739-020-02286-3

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Keywords

  • Infections
  • Post-cardiac arrest
  • Post-arrest care
  • Bacteremia
  • Pneumonia
  • UTI
  • Antibiotics