Systemic antibiotics for preventing ventilator-associated pneumonia in comatose patients: a systematic review and meta-analysis

• Published in: Annals of intensive care Vol. 7; no. 1; p. 67
• Main Authors: Righy, Cássia, do Brasil, Pedro Emmanuel Americano, Vallés, Jordi, Bozza, Fernando A., Martin-Loeches, Ignacio
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 15.06.2017; Springer Nature B.V; SpringerOpen
• Subjects: Anesthesiology; Antibiotics; Coma; Critical Care Medicine; Emergency Medicine; Evidence-based medicine; Intensive; Intensive care; Intubation; Medicine; Medicine & Public Health; Meta-analysis; Mortality; Pneumonia; Systematic review; Ventilation; Ventilator-associated pneumonia; Ventilators; Coma; Systematic review; Ventilator-associated pneumonia; Meta-analysis
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-017-0291-4

Background 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. Methods 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. Results 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). Conclusions 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.