Efficacy of Prophylactic Antibiotics during Extracorporeal Membrane Oxygenation: A Nationwide Cohort Study.
RATIONALE: Extracorporeal membrane oxygenation (ECMO) is widely used worldwide, and many hospitals consider using antibiotics to prevent nosocomial infection in ECMO patients. However, the efficacy of antimicrobial prophylaxis for patients receiving ECMO remains unclear.
OBJECTIVE: This study aimed to evaluate the efficacy of prophylactic antibiotics for ECMO patients.
METHODS: This retrospective cohort study was performed using data recorded in the Japanese Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2017. We compared in-hospital mortality, nosocomial pneumonia, acute kidney injury, and diarrhea between patients receiving prophylactic antibiotics (prophylaxis group) and those not receiving antibiotics (control group) using propensity score matching, multivariable logistic regression models fitted using generalized estimating equation, stabilized inverse probability of treatment weighting, and instrumental variable analysis.
RESULTS: We identified 9615 eligible patients and classified them into the prophylaxis (n = 5552) and control (n = 4063) groups. In the propensity score-matched analysis, 3650 pairs were generated. Significant differences between the prophylaxis group and the control group were detected in in-hospital mortality (56.4% vs 59.8%, risk difference: -3.7%, 95% confidence interval [CI]: -6.0 to -1.3) and nosocomial pneumonia (12.9% vs. 15.3%, risk difference: -2.4%, 95% CI: -4.3 to -0.6). In the multivariable logistic regression models fitted using generalized estimating equation, stabilized inverse probability of treatment weighting, and instrumental variable analysis, the point estimates a suggested similar direction to that found in the propensity score analysis. The proportions of patients with acute kidney injury or diarrhea did not significantly increase with the use of prophylactic antibiotics.
CONCLUSION: Using prophylactic antibiotics during ECMO was associated with reduced in-hospital mortality and lower proportions of patients with nosocomial pneumonia. Future prospective studies are needed to validate these results.
|ジャーナル名||Annals of the American Thoracic Society|
|投稿者||Kondo, Yutaka; Ohbe, Hiroyuki; Aso, Shotaro; Matsui, Hiroki; Fushimi, Kiyohide; Tanaka, Hiroshi; Yasunaga, Hideo|
|組織名||Juntendo University Urayasu Hospital, Department of Emergency and Critical Care;Medicine, Urayasu, Chiba, Japan; email@example.com.;The University of Tokyo, 13143, Bunkyo-ku, Japan.;The University of Tokyo, Department of Clinical Epidemiology and Health;Economics, Bunkyo-ku, Tokyo, Japan.;The University of Tokyo, Tokyo, Japan.;Tokyo Medical and Dental University Graduate School of Medicine, Department of;Health Informatics and Policy, Tokyo, Japan.;Medicine, Urayasu, Chiba, Japan.;School of Public Health, The University of Tokyo, Department of Health Economics;and Epidemiology Research, Tokyo, Japan.|