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Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia
Stephan Ehrmann1, François Barbier1, Julien Demiselle1
1From Centre Hospitalier Régional Universitaire (CHRU) de Tours, Médecine Intensive Réanimation, INSERM Centre d'Investigation Clinique (CIC) 1415, Clinical Research in Intensive Care and Sepsis-Trial Group for Global Evaluation and Research in Sepsis (CRICS_TRIGGERSep) French Clinical Research Infrastructure Network (F-CRIN) Research Network (S.E., E.M., D.G., C.S.G.), INSERM, Research Center for Respiratory Diseases (S.E., F.B., N.H.-V., R.R.), the University of Tours (S.E., N.H.-V., R.R.), CHRU de Tours, Réanimation Chirurgicale (M.F.), CHRU de Tours, Pharmacie (R.R.), and CHRU de Tours, INSERM CIC 1415 and Université de Tours et Nantes, Methods in Patient-Centered Outcomes and Health Research, INSERM 1246 (E.T.), Tours, Centre Hospitalier et Universitaire (CHU) d'Orléans, Médecine Intensive Réanimation, Orléans (F.B., M.-A.N., D.B.), Médecine Intensive-Réanimation, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil and INSERM, Unité Mixte de Recherche (UMR) 1260, Regenerative Nanomedicine, Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (J.D., F.M., H.M.), and Hôpitaux Universitaires de Strasbourg, Hôpital Hautepierre, Médecine Intensive Réanimation (J.-E.H., R.C.-J.), Strasbourg, the Department of Intensive Care, Burgundy University Hospital and Lipness Team, INSERM Research Center Lipids, Nutrition, Cancer (LNC)-UMR1231 and LabEx LipSTIC, University of Burgundy, and INSERM CIC 1432, Clinical Epidemiology, University of Burgundy (J.-P.Q.), and the Department of Intensive Care, Burgundy University Hospital (P.A.), Dijon, Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Louis Mourier, Départements Médico-Universitaires Enseignements et Soins de Proximité, Recherche, Innovation et Territoires (DMU ESPRIT), Service de Médecine Intensive Réanimation, Colombes (D.R., N.Z.), INSERM/French National Center for Scientific Research, Institut Necker Enfants Malades, Université Paris Cité (D.R.), and Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University (Q.L.), Paris, Centre Hospitalier Départemental Vendée, Médecine Intensive Réanimation, La Roche sur Yon (J.-C.L., M.-A.A.), Centre Hospitalier (CH) du Mans, Médecine Intensive Réanimation, Le Mans (M.L., M.S.-M.), CHU de Rennes, Réanimation Chirurgicale, Rennes (P.S.), CH Angoulême, Médecine Intensive Réanimation, Angoulême (D.S.), CHU de Poitiers, Médecine Intensive Réanimation (A.V.), Université de Poitiers, INSERM, Pharmacologie des Anti-Infectieux et Antibiorésistance (PHAR2), Unité 1070 and CHU de Poitiers, Anesthésie-Réanimation-Médecine Péri-Opératoire, F-86000 (C.D.-F.), Université de Poitiers, PHAR2 INSERM U1070 (N.G.), and CHU de Poitiers, Service de Toxicologie et Pharmacologie (N.G.). Poitiers, CHU de Rouen, Réanimation Chirurgicale (P.G.), University Rouen Normandie, Normandie University, Groupe de Recherche sur le Handicap Ventilatoire et Neurologique, Unité de recherche 3830 and Intensive Care Medicine, Rouen University Hospital (G.B.), Rouen, CHU Angers, Réanimation Chirurgicale, Angers (S.L.), CH d'Argenteuil, Réanimation Polyvalente, Argenteuil (G.P.), and Réanimation Médicale, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon (N.C.) - all in France; and the Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China (Q.L.).
Inhaled amikacin significantly reduced ventilator-associated pneumonia in critically ill adults. This 3-day treatment offers a promising strategy for preventing this serious infection in mechanically ventilated patients.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Ventilator-associated pneumonia (VAP) is a significant concern in critically ill patients requiring mechanical ventilation.
- The efficacy of prophylactic inhaled antibiotics in reducing VAP incidence remains uncertain.
Purpose of the Study:
- To evaluate whether inhaled amikacin can decrease the incidence of ventilator-associated pneumonia in adults on mechanical ventilation.
- To assess the safety of inhaled amikacin in this patient population.
Main Methods:
- A multicenter, double-blind, randomized, controlled superiority trial was conducted.
- Critically ill adults on mechanical ventilation for at least 72 hours received inhaled amikacin (20 mg/kg ideal body weight) or placebo daily for 3 days.
- The primary outcome was the first episode of VAP within 28 days.
Main Results:
- VAP developed in 15% of the amikacin group versus 22% in the placebo group (P=0.004).
- Infection-related ventilator-associated complications were also reduced in the amikacin group (18% vs. 26%).
- Serious adverse effects were rare and comparable between groups.
Conclusions:
- A 3-day course of inhaled amikacin effectively reduced the incidence of ventilator-associated pneumonia in mechanically ventilated patients.
- Inhaled amikacin is a safe and effective preventive strategy for VAP in this high-risk group.
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