Publish in this journal
Journal Information
Vol. 41. Num. 8.November 2017
Pages 451-510
Download PDF
More article options
Vol. 41. Num. 8.November 2017
Pages 451-510
Letter to the Editor
DOI: 10.1016/j.medin.2017.06.001
Full text access
Reply to “Antibiotic resistance: thinking outside the hospital”
Respuesta a «Resistencia a antibióticos: pensando fuera del hospital»
J.M. Sirvent
Corresponding author
, J. González
Department of Intensive Care (ICU), Study Group of Infections in Critically Ill Patients, Institut d’Investigació Biomèdica de Girona (IDIBGI), Hospital Universitari de Girona Doctor Josep trueta, Girona, Spain
Related content
Med Intensiva 2017;41:504-510.1016/j.medin.2017.05.008
A.J. Roldán-Reina, R. Martín-Bermúdez, Y. Corcia-Palomo, L. Martín-Villén
This item has received
Article information
Full Text
Download PDF
Dear Editor,
Full Text

We have read with interest the letter by Roldán-Reina et al.1 in relationship with our point of view published in this journal2 referring to the original article published 20 years ago.3 We fully agree with the authors on their concern for progressive resistance of micro-organisms that cause respiratory infection to cefuroxime and amoxicillin-clavulanic and consequently that they have become obsolete, these antibiotics should not be used for the prevention of ventilator-associated pneumonia in intubated coma patients.

The authors described the results of their recent retrospective and observational study4 to evaluate the resistance patterns of the common microorganisms isolated from bronchial aspirates in patients admitted to the ICU after resuscitated cardiac arrest. In the study the most frequent were Staphylococcus aureus (22.2%), Escherichia coli (14.8%), Enterobacter cloacae (14.8%), Klebsiella pneumoniae (11.1%), Serratia marcescens (11.1%) and Haemophilus influenzae (7.4%). They observed that 48.1% of the isolated microorganisms were resistant to amoxicillin-clavulanic, 18.5% to piperacillin-tazobactam and 14.8% to third-generation cephalosporin. They described no microorganism was resistant to quinolones or carbapenems.

Thus, the authors give us an approximate idea as to what might be an alternative to cefuroxime for prevention of ventilator-associated pneumonia in coma patients, and we believe is time to develop new RCT to study other antibiotics for prophylaxis with no effect on normal anaerobic microbiota and with a broad-spectrum to Gram-positive and enteric Gram-negative bacilli. A good alternative to cefuroxime might be levofloxacin, because the pharmacological properties are suitable and it is active against the causative micro-organisms.5 However, we should pay special attention to the development of local antibiotic resistance, and maintaining the antibiotic prophylaxis only 24h (one dose in case of levofloxacin).

A.J. Roldán-Reina,R. Martín-Bermúdez,Y. Corcia-Palomo,L. Martín-Villén
Antibiotic resistance: thinking outside the hospital
Med Intens, 41 (2017), pp. 504-505
J.M. Sirvent
Antibiotic prophylaxis against ventilator-associated pneumonia in patients with coma: where are we now
Med Intens, 41 (2017), pp. 248-251
J.M. Sirvent,A. Torres,M. El-Ebiary,P. Castro,J. de Batlle,A. Bonet
Protective effect of intravenously administered cefuroxime against nosocomial pneumonia in patients with structural coma
Am J Respir Crit Care Med, 155 (1997), pp. 1729-1734
A.J. Roldán-Reina,Y. Corcia-Palomo,R. Martín-Bermúdez
Empiric antibiotic therapy after cardiac arrest
Med Clin (Barc), 148 (2017), pp. 92-93
P.E. Marik
Aspiration pneumonitis and aspiration pneumonia
N Engl J Med, 344 (2001), pp. 665-671
Copyright © 2017. Elsevier España, S.L.U. y SEMICYUC
Medicina Intensiva (English Edition)

Subscribe to our Newsletter

Article options
es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?