Antibiotics for hospital-acquired pneumonia in neonates and children
Steven Kwasi Korang1, Chiara Nava2, Sutharshini Punniyamoorthy Mohana3
1Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Insights
The effectiveness of various antibiotic treatments for hospital-acquired pneumonia in children remains uncertain due to limited, low-quality evidence. More research is needed to determine the best antibiotic regimens for pediatric hospital-acquired infections.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Hospital-acquired pneumonia (HAP) is a common hospital-acquired infection in children globally.
- Current understanding of pediatric HAP is largely based on adult studies.
- No prior systematic reviews with meta-analysis have evaluated antibiotic regimens for HAP in neonates and children.
Purpose of the Study:
- To assess the benefits and harms of different antibiotic regimens for HAP in neonates and children.
- To synthesize available evidence on antibiotic efficacy and safety in this population.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials (RCTs).
- Searched multiple databases (CENTRAL, MEDLINE, Embase) and trial registers up to February 2021.
- Included RCTs comparing antibiotic regimens for HAP in neonates and children; assessed risk of bias and certainty of evidence (GRADE).
Main Results:
- Included four RCTs with 84 participants; all trials had a high risk of bias.
- No meta-analyses were conducted due to dissimilar antibiotic comparisons (cefepime vs. ceftazidime, linezolid vs. vancomycin, meropenem vs. cefotaxime, ceftobiprole vs. cephalosporin).
- Very low certainty of evidence; insufficient data to draw meaningful conclusions or determine superiority of any regimen.
Conclusions:
- The comparative benefits and harms of different antibiotic regimens for pediatric HAP are unclear.
- Current evidence is insufficient to support any specific antibiotic regimen over another.
- Further high-quality RCTs are warranted to guide treatment of HAP in neonates and children.
Background:
Hospital-acquired pneumonia is one of the most common hospital-acquired infections in children worldwide. Most of our understanding of hospital-acquired pneumonia in children is derived from adult studies. To our knowledge, no systematic review with meta-analysis has assessed the benefits and harms of different antibiotic regimens in neonates and children with hospital-acquired pneumonia.
Objectives:
To assess the beneficial and harmful effects of different antibiotic regimens for hospital-acquired pneumonia in neonates and children.
Search Methods:
We searched CENTRAL, MEDLINE, Embase, three other databases, and two trial registers to February 2021, together with reference checking, citation searching, and contact with study authors to identify additional studies.
Selection Criteria:
We included randomised clinical trials comparing one antibiotic regimen with any other antibiotic regimen for hospital-acquired pneumonia in neonates and children.
Data Collection And Analysis:
Three review authors independently assessed studies for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of the evidence using the GRADE approach. Our primary outcomes were all-cause mortality and serious adverse events; our secondary outcomes were health-related quality of life, pneumonia-related mortality, non-serious adverse events, and treatment failure. Our primary time point of interest was at maximum follow-up.
Main Results:
We included four randomised clinical trials (84 participants). We assessed all trials as having high risk of bias. We did not conduct any meta-analyses, as the included trials did not compare similar antibiotic regimens. Each of the four trials assessed a different comparison, as follows: cefepime versus ceftazidime; linezolid versus vancomycin; meropenem versus cefotaxime; and ceftobiprole versus cephalosporin. Only one trial reported our primary outcomes of all-cause mortality and serious adverse events. Three trials reported our secondary outcome of treatment failure. Two trials primarily included community-acquired pneumonia and hospitalised children with bacterial infections, hence the children with hospital-acquired pneumonia constituted subgroups of the total sample sizes. Where outcomes were reported, the certainty of the evidence was very low for each of the comparisons. We are unable to draw meaningful conclusions from the numerical results. None of the included trials assessed health-related quality of life, pneumonia-related mortality, or non-serious adverse events.
Authors' Conclusions:
The relative beneficial and harmful effects of different antibiotic regimens remain unclear due to the very low certainty of the available evidence. The current evidence is insufficient to support any antibiotic regimen being superior to another. Randomised clinical trials assessing different antibiotic regimens for hospital-acquired pneumonia in children and neonates are warranted.
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