Evidence map›Paper›PMID 27635693›Full record

ArticleSurgical infections2016

Intubated Trauma Patients Receiving Prolonged Antibiotics for Pneumonia despite Negative Cultures: Predictors and Outcomes.

Tyler J Loftus, Scott C Brakenridge, Frederick A Moore, Stephen J Lemon, Linda L Nguyen, Stacy A Voils, Janeen R Jordan, Chasen A Croft, R Stephen Smith, Phillip A Efron and 1 more

Registry-linked trialOpen access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Surgical infections, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04438187 (Trial of Antimicrobial Restraint in Presumed Pneumonia), which is not on this map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact, top 90% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04438187 nacompletednot on this mapstarted 2021, after this paper: background citation

Trial of Antimicrobial Restraint in Presumed Pneumonia

TypeinterventionalSponsorUniversity of Kansas Medical CenterRan2021 to 2022Enrolled186ConditionsHealthcare-Associated Pneumonia, SepsisArmsantimicrobial initiation
3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 2 institutions in 1 country.

Tyler J LoftusDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Scott C BrakenridgeDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Frederick A MooreDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Stephen J LemonDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Linda L NguyenDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Stacy A VoilsDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Janeen R JordanDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Chasen A CroftDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
R Stephen SmithDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Phillip A EfronDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Alicia M MohrDepartment of Surgery and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine , Gainesville, Florida.
Florida College · USUniversity of Florida · US

Funding

PICS: A New Horizon for Surgical Critical CareP50GM111152 · NIGMS · UNIVERSITY OF FLORIDA · PI MOORE, FREDERICK A · 2014 to 2018
$10.7M
Molecular Biology in Burns and TraumaT32GM008721 · NIGMS · UNIVERSITY OF FLORIDA · PI Philip A Efron · 1999 to 2026
$5.0M
Chronic Stress and Anemia Recovery following Major TraumaR01GM105893 · NIGMS · UNIVERSITY OF FLORIDA · PI MOHR, ALICIA M · 2013 to 2021
$3.5M
Validation of a Genomics Based Prognostic in Severe TraumaR01GM104481 · NIGMS · UNIVERSITY OF FLORIDA · PI MOLDAWER, LYLE L · 2013 to 2016
$1.8M
Hematopoietic Stem Cell Dysfunction in the Elderly after Severe InjuryR01GM113945 · NIGMS · UNIVERSITY OF FLORIDA · PI EFRON, PHILIP A · 2015 to 2019
$1.6M
NIGMS NIH HHS P50 GM111152NIGMS NIH HHS R01 GM104481NIGMS NIH HHS R01 GM105893NIGMS NIH HHS R01 GM113945NIGMS NIH HHS T32 GM008721
6 · The paper itself

Abstract

backgroundDespite the excellent negative predictive value of sterile respiratory cultures, antibiotics often are continued after negative endotracheal aspirate (ETA) or bronchoalveolar lavage (BAL) for critically ill trauma patients. We hypothesized that persistent elevation of the Clinical Pulmonary Infection Score (CPIS) would predict continued antibiotic therapy after a negative respiratory culture for intubated trauma patients, and that prolonged antibiotics would provide no benefit.

methodsWe performed a four-year retrospective cohort analysis (May 1, 2011-September 30, 2015), including patients from our trauma database with ETA or BAL, excluding patients with any infection other than pneumonia or bacteremia. Cultures with <2

resultsA series of 106 patients with negative cultures were included, of whom 61 had ≤5 d of antibiotics and 45 had >5 d of antibiotics. There were no differences in injury severity, head or chest trauma, initial CPIS, or subsequent culture results between the groups. Long-term antibiotic therapy did not affect intensive care unit (ICU) length of stay (LOS), ventilator days, hospital LOS, or death. Factors predicting long-term antibiotic therapy included development of a localized chest radiograph infiltrate (odds ratio [OR] 6.8; 95% confidence interval [CI] 1.7-28), CPIS >5 five days after culture (OR 6.1; 95% CI 1.2-32), and a colonized culture (OR 3.3; 95% CI 1.3-8.3).

conclusionsLong-term antibiotic therapy for intubated trauma patients with negative respiratory cultures provided no benefit and was predicted by development of a localized chest radiograph infiltrate, persistently elevated CPIS, and a contaminated/colonized culture. Although long-term antibiotic use did not worsen outcomes, better strategies are needed to diagnose pneumonia accurately and ensure timely discontinuation of antibiotics when appropriate.

Indexed as

Anti-Bacterial AgentsFemaleHumansIntubation, IntratrachealMaleMiddle AgedPneumonia, BacterialRetrospective StudiesRisk FactorsTreatment OutcomeWounds and InjuriesAnti-Bacterial Agents

Identifiers

PMID27635693
PMCPMC5124750
OpenAlexW2518949951

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.