Ly with an hourly delay in antibiotic administration. Overall mortality with sepsis was 34.2 . Conclusions Administration of appropriate antibiotics within 4 hours of arrival in the ER has a significantly favorable impact on survival in patients with sepsis.P84 Protective effect of antibiotic prophylaxis against earlyonset nosocomial pneumonia in comatose patientsJ Navellou, C Manzon, M Puyraveau, D Perez, E Laurent, C Patry, G Capellier CHU Jean Minjoz, Besancon, France Critical Care 2007, 11(Suppl 2):P84 (doi: 10.1186/cc5244) Objective To study the impact of prophylactic antibiotics on the occurrence of early-onset nosocomial pneumonia in patients with medical coma.SCritical CareMarch 2007 Vol 11 Suppl27th International Symposium on Intensive Care and Emergency MedicinePatients and methods An open, before and after, single-center trial, in the medical ICU of the University Hospital of Besancon, France. A first CXCR2-IN-1 chemical information period (A, retrospective) extended during 18 months (April 2003 ctober 2004) without antibiotic prophylaxis and was followed by a second period (B, prospective) during 18 months (November 2004 pril 2006). Patients received prophylaxis treatment by amoxicillin PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20799915 and clavulanic acid, shortly after intubation and during a 24-hour period. Inclusion criteria were medical loss of consciousness, Glasgow Coma Score < 8, and length of intubation > 48 hours. Results A total of 101 patients were enrolled, 61 patients during period A and 40 patients during period B. No significant differences were found between mean age (48.6 years vs 50.4 years old), SAP II score (44.5 vs 46.5), aetiology of coma (mainly ischaemic stroke, cardiac arrest, refractory epilepsy, intoxication), and early-onset (n = 12 vs n = 6) or late-onset pneumonia (n = 1 vs n = 2). During period B, the time for onset of colonisation (6.6 days vs 3 days, P = 0.008) or pneumonia (8.4 days vs 4.2 days, P = 0.03) was increased compared with period A. We did not diagnose multidrug-resistant infection or colonisation. No difference was found with regard to mortality and morbidity: duration of mechanical ventilation (5.7 days vs 6.7 days) or total hospitalisation stay (26.6 days vs 16.9 days), total mortality (n = 9 vs n = 10 patients) or at day 28 (n = 6 vs n = 7 patients), respectively, in periods A and B. In multivariate analysis, tobacco, cardiac arrest and ischaemic stroke were independent risk factors of pneumonia. Conclusion In our study, contrary to previous ones [1,2], antibioprophylaxy did not show a decrease in the incidence of nosocomial pneumonia in medical comatose patients with Glasgow Coma Score < 8 under mechanical ventilation. On the other hand, antibiotics induce a later onset of colonisation and lung infections. Despite a prevention of early-onset nosocomial pneumonia, our data do not support the use of regular prophylactic antibiotics. Method Following appropriate institutional approval, 43 ICUs were selected using the proportional probability sampling technique. This was applied to a national database of ICUs. Every seventh bed was selected from all the serially placed units. Antibiotic therapy was reviewed by two independent reviewers. Data collected included the appropriateness of pretherapy cultures,SAvailable online http://ccforum.com/supplements/11/Srespiratory organ failure. There was no difference in the presence of renal dysfunction. Late admissions with pneumonia had higher ICU and hospital mortality, and longer hospital stay. At each CURB 65 score the.