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

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CE - LETTER TO THE EDITOR

Infections in out‑of‑hospital and in‑hospital post‑cardiac arrest patients: comment Sombat Muengtaweepongsa1   · Sirinat Puengcharoen1 Received: 1 May 2020 / Accepted: 4 May 2020 © Società Italiana di Medicina Interna (SIMI) 2020

Dear Editor, We read with interest the article by Mortensen et al. [1] according to infections in out-of-hospital and in-hospital post-cardiac arrest patients. In this single-center study, the authors reported the microbial profile of infections in postcardiac arrest patients. Here, we would like to share our bacterial profile of infections in the out-of-hospital post-cardiac arrest (OHCA) in our center and discuss the importance of the results. Thammasat University Hospital (TUH) is a 700-bed hospital in Thailand with a 100-bed intensive care facility. We reviewed medical records of the OHCA patients, who were at least 15 years old, admitted to TUH between October 2016 to September 2018. Seventy-five OHCA patients were collected. Three and twenty-seven of them were excluded due to pre-existing infection and admission less than 24-h, respectively. Forty-five remained for analysis, and twentynine of them were treated with TTM. The mean age of the patients in the TTM group was 56.48 ± 15 years, with 75% male. The most common initial rhythm of cardiac arrest was the shockable subtype (47%). The most common cause of arrest was cardiac origin (83%). Seventeen patients in the TTM group developed a nosocomial infection (60%). The most common infection was pneumonia (50%), as shown in Fig. 1b. The most common organisms included Klebsiella pneumonia (56%), Pseudomonas aeruginosa (11%), Escherichia coli (11%), Acinetobacter baumannii (11%), and Staphylococcus aureus (5.5%), respectively (Fig. 1a). The most common antibiotics prescribed for the treatment were piperacillin/tazobactam (43%), ceftriaxone (25%) and ceftazidime (11%), respectively. The Cerebral Performance

Category Scale (CPC) of the patients in the TTM group at discharge from the intensive care unit were CPC 5 at 41%, CPC 4 at 28%, CPC 3 at 7%, CPC 2 at 7% and CPC 1 at 17%, respectively. Our data and which reported by Mortensen et al. [1] support the findings from the previous study that pneumonia remains the most common source of infection in post-cardiac arrest patients [2, 3]. Treatment with TTM is an independent risk factor for the occurrence of pneumonia after restored of spontaneous circulation (ROSC) [3]. Pneumonia is also common when TTM is applied for the treatment in other indications outside cardiac arrest [4]. The bacterial profiles reported in our study are contrasted from which of Mortensen et al. [1]. The gram-negative bacteria are the most common pathogens in our study, while, in the study of Mortensen et al. [1], Staphylococcus aureus becomes the most common one. This phenomenon may reflect the geographic effect on the nature of the bacterial infection. The microbial profile of infection in post-cardiac arrest should be individually unique for each center. The bacterial profile is essential f