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EFFICACY OF SINGLE-DOSE ANTIBIOTIC ADMINISTRATION TO COMATOSE VENTILATOR PATIENTS FOR PROPHYLAXIS OF EARLY-ONSET PNEUMONIA

Mahnoor Khalil Ahmed, Baquar Raza, Bushra Rehman, Akbar Gohar, Arshad Sattar Lakho, Tahir Hanif, Muhammad Muneeb, Aatir H. Rajput & Asma Rajput

Abstract: Background: Nosocomial pneumonias are recognized as an important cause of morbidity and mortality and comatose patients present a particularly high risk of early-onset ventilator-associated pneumonia (EO-VAP) for which antibiotic prophylaxis has been proposed. Objective: To evaluate the efficacy of a single-dose of antibiotic prophylaxis at intubation against EO-VAP. Methodology: This prospective cohort was conducted upon a sample of 400 comatose patients (Glasgow Coma Score 8) admitted to the Abbasi Shaheed Hospital, Karachi from June 2018 to December 2018 and administered a single-dose of antibiotic within 4 h of intubation and additionally comatose patients (admitted 4 h after intubation admitted from January 2018 to May 2018 who did not receive antibiotic prophylaxis. The incidence of EO-VAP, late-onset VAP, and ventilator-associated trachea-bronchitis was noted in both groups. The data obtained was recorded onto a structured questionnaire and analyzed using SPSS v.21 & Microsoft Excel 2016. Results: Among, the 300 patient enrolled into the study, 29% were males while the remaining 71% were females. The mean age of the sample stood at 41 (SD ± 7). The incidence of VAP and incidence of EO-VAP were lower in the prophylaxis group. The incidence of late-onset VAP did not differ. The prophylaxis group yielded a lower incidence of ventilator-associated trachea-bronchitis. No differences in mortality were found between groups. Regression analysis confirmed that a single dose of antibiotic prophylaxis was independently associated with lower incidence of EO-VAP. Conclusion: After careful consideration, it can be concluded that single dose of antibiotic prophylaxis at intubation might lower the incidence of EO-VAP. However, a randomized clinical trial should be conducted to confirm our findings. Keywords: Nosocomial Pneumonia, Ventilator Associated Pneumonia, Trachea-Bronchitis, Efficacy, Antibiotic Therapy and Prophylaxis.

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