What does this research mean for the field?

Among post-cardiac arrest patients receiving antibiotics, those with positive blood cultures experience significantly fewer days alive and ventilator-free and higher in-hospital mortality compared to culture-negative patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This analysis aims to evaluate the effectiveness of antibiotics in patients with positive and negative blood cultures after cardiac arrest.

March 26, 2026

1502: A Comparative Analysis of Antibiotics in Culture-Positive and Negative Patients Post-Cardiac Arrest

Key Points

This analysis aims to evaluate the effectiveness of antibiotics in patients with positive and negative blood cultures after cardiac arrest.
Retrospective, multicenter, cohort study
Included adults ≥18 years receiving intravenous antibiotics within 24 hours of ROSC
Patients classified as culture-positive or culture-negative within 72 hours
Primary outcome was days alive and ventilator-free at day 28
Used bivariate and multivariable logistic regression with Win-Ratio analysis.
Culture-negative patients had a significantly higher DAVF with a win ratio of 2.25 (p < 0.0001)
In-hospital mortality was higher in culture-positive patients (72% vs. 54%, p=0.008)
No significant differences in ICU length of stay or adverse events
Antibiotic de-escalation was more common in culture-positive patients (46%) than escalation (7%)
Independent predictors of 28-day mortality included culture positivity, age >65 years, and ≥2 SIRS criteria.

Abstract

Introduction: Sepsis-associated cardiac arrest may lead to worse outcomes than non-infectious cases, due to ongoing organ dysfunction after return of spontaneous circulation (ROSC). Literature suggests ~10% of patients with ROSC have positive blood cultures (Bcx), but data guiding antibiotic use is limited. Guidelines do not recommend routine antibiotics (Abx) but promote individualized decisions. This study compared outcomes between patients who received Abx and achieved ROSC, categorized by their positive or negative Bcx. Methods: This IRB-approved, multicenter, retrospective, cohort study included adults ≥18 years old who received intravenous (IV) Abx for ≥ 2 days within 24 hours of ROSC between Jan 1, 2019, and Jun 30, 2024. Exclusion criteria: expired within 48 hours, received Abx pre-ROSC, or had COVID-19. Patients were classified into culture-positive or culture-negative cohorts within 72 hours of ROSC. The primary outcome was days alive and ventilator-free (DAVF) at day 28. Secondary endpoints included ICU length of stay, in-hospital mortality, adverse events, and Abx-related outcomes. Bivariate and multivariable logistic regression were used as appropriate along with Win-Ratio analysis. Results: 100 patients were included in each group. Culture-negative patients had significantly more DAVF, with a win ratio of 2.25 (95% confidence interval CI, 2.13–2.37; p < 0.0001). Within the culture positive group, Abx escalation occurred at 7% while de-escalation occurred at 46%. In-hospital mortality was higher in culture-positive patients (72% vs. 54%, p=0.008), otherwise there were no notable differences in secondary endpoints including ICU length of stay, adverse events, and abx-related outcomes. Culture positivity, age above 65 years, and ≥2 SIRS criteria independently predicted 28-day mortality. Conclusions: Patients with a positive-blood culture after ROSC were associated with fewer DAVF and higher mortality. Early assessment for sepsis after ROSC and development of accurate tools to recognize this condition is critical.

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Cite This Study

Cheaito et al. (Sun,) studied this question.

synapsesocial.com/papers/69c4cd5afdc3bde448919802 https://doi.org/https://doi.org/10.1097/01.ccm.0001188004.91446.53

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