Department of Critical Care, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece.
4th Department of Internal Medicine, Medical School, University of Athens, "Attikon" University Hospital, Athens, Greece.
Chest. 2013 Dec;144(6):1759-1767. doi: 10.1378/chest.13-0076.
We performed a systematic review and meta-analysis of short- vs long-duration antibiotic regimens for ventilator-associated pneumonia (VAP).
We searched PubMed and Cochrane Central Registry of Controlled Trials. Four randomized controlled trials (RCTs) comparing short (7-8 days) with long (10-15 days) regimens were identified. Primary outcomes included mortality, antibiotic-free days, and clinical and microbiologic relapses. Secondary outcomes included mechanical ventilation-free days, duration of mechanical ventilation, and length of ICU stay.
All RCTs included mortality data, whereas data on relapse and antibiotic-free days were provided in three and two out of four RCTs, respectively. No difference in mortality was found between the compared arms (fixed effect model [FEM]: OR = 1.20; 95% CI, 0.84-1.72; P = .32). There was an increase in antibiotic-free days in favor of the short-course treatment with a pooled weighted mean difference of 3.40 days (random effects model: 95% CI, 1.43-5.37; P < .001). There was no difference in relapses between the compared arms, although a strong trend to lower relapses in the long-course treatment was observed (FEM: OR = 1.67; 95% CI, 0.99-2.83; P = .06). No difference was found between the two arms regarding the remaining outcomes. Sensitivity analyses yielded similar results.
Short-course treatment of VAP was associated with more antibiotic-free days. No difference was found regarding mortality and relapses; however, a strong trend for fewer relapses was observed in favor of the long-course treatment, being mostly driven by one study in which the observed relapses were probably more microbiologic than clinical. Additional research is required to elucidate the issue.
我们对呼吸机相关性肺炎（VAP）的短疗程与长疗程抗生素治疗进行了系统评价和荟萃分析。
我们检索了 PubMed 和 Cochrane 对照试验中心注册库。确定了 4 项比较短程（7-8 天）与长程（10-15 天）方案的随机对照试验（RCT）。主要结局包括死亡率、抗生素无天数和临床及微生物学复发。次要结局包括机械通气无天数、机械通气持续时间和 ICU 住院时间。
所有 RCT 均提供了死亡率数据，而 4 项 RCT 中有 3 项提供了复发和抗生素无天数数据，2 项提供了该数据。比较组之间的死亡率无差异（固定效应模型[FEM]：OR=1.20；95%CI，0.84-1.72；P=0.32）。短程治疗组抗生素无天数增加，合并加权均数差为 3.40 天（随机效应模型：95%CI，1.43-5.37；P < 0.001）。比较组之间的复发无差异，但长程治疗组的复发率有降低的趋势（FEM：OR=1.67；95%CI，0.99-2.83；P=0.06）。两组在其余结局方面无差异。敏感性分析得出了相似的结果。
VAP 的短程治疗与更多的抗生素无天数相关。死亡率和复发方面无差异；然而，长程治疗的复发率较低，这主要是由一项研究中的观察复发更倾向于微生物学而非临床。需要进一步的研究来阐明这个问题。
