Nebulized antibiotics for ventilator-associated pneumonia: a systematic review and meta-analysis

Imagem de Miniatura
Arquivos
art_ZAMPIERI_Nebulized_antibiotics_for_ventilatorassociated_pneumonia_a_systematic_review_2015.PDF (1.54 MB)
Citações na Scopus
90
Tipo de produção
article
Data de publicação
2015
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BIOMED CENTRAL LTD
Autores
GUSMAO-FLORES, Dimitri
TORRES, Antoni
Citação
CRITICAL CARE, v.19, article ID 150, 12p, 2015
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Introduction: Nebulized antibiotics are a promising new treatment option for ventilator-associated pneumonia. However, more evidence of the benefit of this therapy is required. Methods: The Medline, Scopus, EMBASE, Biological Abstracts, CAB Abstracts, Food Science and Technology Abstracts, CENTRAL, Scielo and Lilacs databases were searched to identify randomized controlled trials or matched observational studies that compared nebulized antibiotics with or without intravenous antibiotics to intravenous antibiotics alone for ventilator-associated pneumonia treatment. Two reviewers independently collected data and assessed outcomes and risk of bias. The primary outcome was clinical cure. Secondary outcomes were microbiological cure, ICU and hospital mortality, duration of mechanical ventilation, ICU length of stay and adverse events. A mixed-effect model meta-analysis was performed. Trial sequential analysis was used for the main outcome of interest. Results: Twelve studies were analyzed, including six randomized controlled trials. For the main outcome analysis, 812 patients were included. Nebulized antibiotics were associated with higher rates of clinical cure (risk ratio (RR) = 1.23; 95% confidence interval (CI), 1.05 to 1.43; I-2 = 34%; D-2 = 45%). Nebulized antibiotics were not associated with microbiological cure (RR = 1.24; 95% CI, 0.95 to 1.62; I-2 = 62.5), mortality (RR = 0.90; CI 95%, 0.76 to 1.08; I-2 = 0%), duration of mechanical ventilation (standardized mean difference = -0.10 days; 95% CI, -1.22 to 1.00; I-2 = 96.5%), ICU length of stay (standardized mean difference = 0.14 days; 95% CI, -0.46 to 0.73; I-2 = 89.2%) or renal toxicity (RR = 1.05; 95% CI, 0.70 to 1.57; I-2 = 15.6%). Regarding the primary outcome, the number of patients included was below the information size required for a definitive conclusion by trial sequential analysis; therefore, our results regarding this parameter are inconclusive. Conclusions: Nebulized antibiotics seem to be associated with higher rates of clinical cure in the treatment of ventilator-associated pneumonia. However, the apparent benefit in the clinical cure rate observed by traditional meta-analysis does not persist after trial sequential analysis. Additional high-quality studies on this subject are highly warranted.
Palavras-chave
URI
https://observatorio.fm.usp.br/handle/OPI/9953
Referências
  1. Aarts MAW, 2008, CRIT CARE MED, V36, P108, DOI 10.1097/01.CCM.0000297956.27474.9D
  2. American Thoracic Society Infectious Diseases Society of America, 2005, AM J RESP CRIT CARE, V171, P388, DOI 10.1164/RCCM.200405-644ST
  3. Ari A, 2012, J AEROSOL MED PULM D, V25, P319, DOI 10.1089/jamp.2011.0936
  4. Arnold HM, 2012, RESP CARE, V57, P1226, DOI 10.4187/respcare.01556
  5. Bassetti M, 2014, INTENS CARE MED, V40, P422, DOI 10.1007/s00134-013-3190-7
  6. Betrán Ana P, 2005, BMC Med Res Methodol, V5, P6, DOI 10.1186/1471-2288-5-6
  7. Biggerstaff BJ, 1997, STAT MED, V16, P753, DOI 10.1002/(SICI)1097-0258(19970415)16:7<753::AID-SIM494>3.3.CO;2-7
  8. Dhand R, 2008, EXPERT REV MED DEVIC, V5, P9, DOI 10.1586/17434440.5.1.9
  9. Doshi NM, 2013, BMC ANESTHESIOL, V13, DOI 10.1186/1471-2253-13-45
  10. Ehrmann S, 2013, INTENS CARE MED, V39, P1048, DOI 10.1007/s00134-013-2872-5
  11. Forel JM, 2012, CRIT CARE, V16, DOI 10.1186/cc11312
  12. Ghannam DE, 2009, EUR J CLIN MICROBIOL, V28, P253, DOI 10.1007/s10096-008-0620-5
  13. Hallal Ali, 2007, Surg Infect (Larchmt), V8, P73, DOI 10.1089/sur.2006.051
  14. Higgins Julian P T, 2011, BMJ, V343, pd5928, DOI 10.1136/bmj.d5928
  15. HONEYBOURNE D, 1994, THORAX, V49, P104, DOI 10.1136/thx.49.2.104
  16. Jakobsen JC, 2014, BMC MED RES METHODOL, V14, DOI 10.1186/1471-2288-14-120
  17. Kalin G, 2012, J INFECT CHEMOTHER, V18, P872, DOI 10.1007/s10156-012-0430-7
  18. Kofteridis DP, 2010, CLIN INFECT DIS, V51, P1238, DOI 10.1086/657242
  19. Kollef MH, 2012, INFECT CONT HOSP EP, V33, P250, DOI 10.1086/664049
  20. Kollef MH, 2013, CURR OPIN INFECT DIS, V26, P538, DOI 10.1097/QCO.0000000000000004
  21. Korbila IP, 2010, CLIN MICROBIOL INFEC, V16, P1230, DOI 10.1111/j.1469-0691.2009.03040.x
  22. Kuhn RJ, 2001, CHEST, V120, p94S, DOI 10.1378/chest.120.3_suppl.94S
  23. Le Conte P, 2000, PRESSE MED, V29, P76
  24. Liberati A, 2009, BMJ-BRIT MED J, V339, DOI 10.1136/bmj.b2700
  25. Lu Q, 2010, INTENS CARE MED, V36, P1147, DOI 10.1007/s00134-010-1879-4
  26. Lu Q, 2012, ANESTHESIOLOGY, V117, P1335, DOI 10.1097/ALN.0b013e31827515de
  27. Lu Q, 2011, AM J RESP CRIT CARE, V184, P106, DOI 10.1164/rccm.201011-1894OC
  28. Melsen WG, 2013, LANCET INFECT DIS, V13, P665, DOI 10.1016/S1473-3099(13)70081-1
  29. Michalopoulos AS, 2011, ANN INTENSIVE CARE, V1, DOI 10.1186/2110-5820-1-30
  30. Miller DD, 2003, AM J RESP CRIT CARE, V168, P1205, DOI 10.1164/rccm.200210-1167OC
  31. Niederman MS, 2012, INTENS CARE MED, V38, P263, DOI 10.1007/s00134-011-2420-0
  32. Palmer LB, 2014, AM J RESP CRIT CARE, V189, P1225, DOI 10.1164/rccm.201312-2161OC
  33. Palmer LB, 2009, CURR OPIN CRIT CARE, V15, P413, DOI 10.1097/MCC.0b013e328330abcf
  34. Panidis D, 2005, CHEST, V128, P545, DOI 10.1378/chest.128.2.545
  35. Rangel EL, 2009, J TRAUMA, V67, P91, DOI 10.1097/TA.0b013e3181a8b2b2
  36. Rangel EL, 2009, J TRAUMA, V67, P95
  37. Rattanaumpawan P, 2010, J ANTIMICROB CHEMOTH, V65, P2645, DOI 10.1093/jac/dkq360
  38. Rouby JJ, 2012, ANESTHESIOLOGY, V117, P1364, DOI 10.1097/ALN.0b013e3182755d7a
  39. ROZNIECKI J, 1978, LUNG, V154, P283
  40. Shrier I, 2007, AM J EPIDEMIOL, V166, P1203, DOI 10.1093/aje/kwm189
  41. Tumbarello M, 2013, CHEST, V144, P1768, DOI 10.1378/chest.13-1018
  42. Valachis A, 2014, CRIT CARE MED, V43, P527
  43. Wells GA, 2000, NEWCASTLE OTTAWA SCA
  44. Wetterslev J, 2009, BMC MED RES METHODOL, V9, DOI 10.1186/1471-2288-9-86

Coleções
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/09
Artigos e Materiais de Revistas Científicas - LIM/51
Artigos e Materiais de Revistas Científicas - ODS/03