Prophylactic antibiotics for preventing ventilator-associated pneumonia: a pairwise and Bayesian network...

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Pharmacology

Background:

• The efficacy of prophylactic antibiotics for preventing ventilator-associated pneumonia (VAP) in patients on invasive mechanical ventilation (IMV) requires further clarification.
• This study addresses the uncertainty surrounding antibiotic prophylaxis in intensive care unit (ICU) settings.

Purpose of the Study:

• To conduct a network meta-analysis comparing the efficacy and safety of antibiotic prophylaxis in preventing VAP among IMV patients in ICUs.
• To evaluate the impact of prophylactic antibiotics on VAP incidence, mortality, and length of hospital and ICU stays.

Main Methods:

• A comprehensive literature search was performed across PubMed, Web of Science, Embase, and Cochrane Library databases up to December 2021.
• Included studies assessed the effects of prophylactic antibiotics on VAP, mortality, and patient stay durations.
• A Bayesian network meta-analysis was employed to synthesize the data.

Main Results:

• Thirteen studies involving 2144 patients were analyzed.
• Prophylactic antibiotic treatment significantly reduced VAP rates compared to control groups (Risk Ratio = 0.62).
• Aerosolized tobramycin and intravenous ampicillin-sulbactam demonstrated the highest probability of being the most effective VAP prevention regimens.

Conclusions:

• Antibiotic prophylaxis appears to decrease VAP incidence but does not impact mortality in adult IMV patients in ICUs.
• Nebulized tobramycin and intravenous ampicillin-sulbactam show promise as effective VAP prevention strategies.
• Further high-quality randomized controlled trials are necessary to establish definitive clinical recommendations.