Title |
Systemic antibiotics for preventing ventilator-associated pneumonia in comatose patients: a systematic review and meta-analysis
|
---|---|
Published in |
Annals of Intensive Care, June 2017
|
DOI | 10.1186/s13613-017-0291-4 |
Pubmed ID | |
Authors |
Cássia Righy, Pedro Emmanuel Americano do Brasil, Jordi Vallés, Fernando A. Bozza, Ignacio Martin-Loeches |
Abstract |
Early-onset ventilator-associated pneumonia (EO-VAP) is the leading cause of morbidity and mortality in comatose patients. However, VAP prevention bundles focus mainly on late-onset VAP and may be less effective in preventing EO-VAP in comatose patients. Systemic antibiotic administration at the time of intubation may have a role in preventing EO-VAP. Therefore, we evaluated the effectiveness of systemic antibiotic administration in VAP prevention in comatose patients through a systematic review and meta-analysis. We searched for studies published through December 2015 that evaluated systemic antibiotic prophylaxis in comatose patients. Two authors independently selected and evaluated full-length reports of randomized clinical trials or prospective cohorts in patients aged >16 years that evaluated the impact of systemic antibiotics at the time of intubation on EO-VAP compared to placebo or no prophylaxis. The outcome variables were the incidence of EO-VAP, the duration of mechanical ventilation, ICU length of stay, and ICU mortality. We identified 10,988 citations, yielding 26 articles for further analysis; three studies with 267 patients were finally analyzed. Most patients (n = 135) were comatose due to head trauma. Systemic antibiotic administration was associated with decreased incidence of EO-VAP (RR 0.32; 95% CI 0.19-0.54) and shorter ICU LOS (standardized mean difference -0.32; 95% CI -0.56 to -0.08), but had no effect on mortality (RR 1.03; 95% CI 0.7-1.53) or duration of mechanical ventilation (standardized mean difference -0.16; 95% CI -0.41 to 0.08). Antibiotic prophylaxis in comatose patients reduced the incidence of EO-VAP and decreased the ICU stay slightly. Future trials are needed to confirm these results. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 92 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Master | 13 | 14% |
Student > Postgraduate | 8 | 9% |
Other | 7 | 8% |
Student > Bachelor | 7 | 8% |
Student > Doctoral Student | 6 | 7% |
Other | 21 | 23% |
Unknown | 30 | 33% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 29 | 32% |
Nursing and Health Professions | 8 | 9% |
Pharmacology, Toxicology and Pharmaceutical Science | 4 | 4% |
Biochemistry, Genetics and Molecular Biology | 3 | 3% |
Agricultural and Biological Sciences | 3 | 3% |
Other | 12 | 13% |
Unknown | 33 | 36% |