The following is a summary of “Prophylactic Antibiotics Delivered Via the Respiratory Tract to Reduce Ventilator-Associated Pneumonia: A Systematic Review, Network Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials,” published in the May 2024 issue of Critical Care by Li et al.
Researchers conducted a retrospective study investigating whether antibiotics delivered through the respiratory tract can prevent ventilator-associated pneumonia (VAP).
They included adult patients with mechanical ventilation exceeding 48 hours who received antibiotics through inhalation or instillation (with a control group) to prevent VAP. Two groups screened, extracted and evaluated data and assessed bias risk. The GRADE approach was employed to gauge evidence quality. The results of a random-effects model were provided for overall and predefined subgroup meta-analyses. The analysis primarily focused on RCTs, with observational studies used for sensitivity analyses.
The results showed 1,445 patients, including 6 RCTs, with 1,283 patients using nebulizers for antibiotic delivery. No notable bias was found in the RCTs for the primary outcome. Prophylactic antibiotics via the respiratory tract significantly reduced VAP risk (RR 0.69 [95% CI 0.53–0.89]), especially with aminoglycosides (RR 0.67 [0.47–0.97]) or nebulization (RR 0.64 [0.49–0.83]) compared to other antibiotics or instillation. No significant differences were noted in mortality, ventilation duration, ICU/hospital stays, systemic antibiotic duration, tracheostomy need, or adverse events between groups, and the results were confirmed through sensitivity analyses.
Investigators found that preventive antibiotics delivered through the respiratory tract lowered VAP risk in adults on mechanical ventilation for more than 48 hours, especially with nebulized aminoglycosides.
Source: journals.lww.com/ccmjournal/abstract/9900/prophylactic_antibiotics_delivered_via_the.333.aspx