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. 2024 Nov 25;26(2):146-153.
doi: 10.1177/17511437241298518. eCollection 2025 May.

Antibiotic prophylaxis reduced broad-spectrum antibiotics and length of stay in ICU patients with alcohol withdrawal induced refractory delirium tremens

Dunia Al-Hashimi  1 , Martin Kåberg  2   3 , Anders Krifors  4   5 , Michael Wanecek  6   7 , Ola Blennow  5   8
Affiliations

Antibiotic prophylaxis reduced broad-spectrum antibiotics and length of stay in ICU patients with alcohol withdrawal induced refractory delirium tremens

Dunia Al-Hashimi et al. J Intensive Care Soc. .

Abstract

Background: Pneumonia is a well-known complication in patients with severe alcohol withdrawal syndrome (SAWS). Antibiotic prophylaxis in ICU treated SAWS patients may be beneficial but data is lacking. The aims of this study were to investigate the effect of introduction of trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, on use of broad-spectrum antibiotics and ICU length of stay (LOS) in SAWS patients with refractory delirium tremens (rDT).

Methods: Retrospective observational cohort study comparing before (control group) and after the introduction of TMP-SMX prophylaxis in patients admitted to a single center ICU because of alcohol withdrawal induced rDT.

Results: A total of 108 patients were included, 53 patients in the control group and 55 patients in the TMP-SMX group. Baseline characteristics did not differ between the groups (89% male, median age 52 years). The use of broad-spectrum antibiotics was significantly lower in the TMP-SMX group than in the control group (11 vs 70%, p < 0.001). The only variable associated with decreased use of broad-spectrum antibiotics in multiple logistic regression analysis was receiving TMP-SMX (0.06, 95% CI 0.02, 0.19, p-value: <0.001). Median LOS was shorter in the TMP-SMX group than in the control group (61 vs 72 h, p = 0.004). In multiple linear regression analysis receiving TMP-SMX SMX was associated with shorter LOS (-22.7, 95% CI: -41.3, -4.1, p-value: 0.02) and having one or more comorbidities with longer LOS (37.4, 95% CI: 10.4, 64.5, p-value: <0.01).

Conclusion: Prophylaxis with TMP-SMX in ICU-treated rDT patients was associated with reduced use of broad-spectrum antibiotics and reduced ICU LOS.

Keywords: Alcohol withdrawal delirium; antibiotic prophylaxis; intensive care unit; length of stay; pneumonia.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart showing inclusion and exclusion.
See this image and copyright information in PMC

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