Department of Rural Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
Division of Internal Medicine, Ballarat Health Services, Ballarat, Victoria, Australia.
Antimicrob Agents Chemother. 2018 Jul 27;62(8). doi: 10.1128/AAC.00291-18. Print 2018 Aug.
Regimens containing topical polymyxin appear highly effective at preventing ventilator-associated pneumonia (VAP) overall and, more so, VAP caused by Gram-negative bacteria. However, Stoutenbeek's postulates that VAP incidences within studies of topical antibiotics depend on the context of whether the component (control and intervention) groups of each study were concurrent versus nonconcurrent remain untested. The literature was searched for concurrent control (CC) versus nonconcurrent control (NCC) designed studies of respiratory tract applications of topical polymyxin to mechanically ventilated (MV) patients that reported incidences of -associated ventilator-associated pneumonia (PsVAP). Studies of various interventions other than topical polymyxin (nonpolymyxin studies) served to provide additional points of reference. The PsVAP incidences within the component groups of all studies were benchmarked against groups from observational studies. This was undertaken by meta-regression using generalized estimating equation methods. Dot plots, caterpillar plots, and funnel plots enable visual benchmarking. The PsVAP benchmark (and 95% confidence interval [CI]) derived from 102 observational groups is 4.6% (4.0 to 5.3%). In contrast, the mean PsVAP within NCC polymyxin intervention groups (1.6%; CI, 1.0 to 4.5%) is lower than that of all other component group categories. The mean PsVAP within CC polymyxin control groups (9.9%; CI, 7.6 to 12.8%) is higher than that of all other component group categories. The PsVAP incidences of control and intervention groups of studies of respiratory tract applications of polymyxin are dependent on whether the groups were within a concurrent versus nonconcurrent study. Stoutenbeek's concurrency postulates are validated.
含有局部多粘菌素的方案在预防呼吸机相关性肺炎（VAP）方面总体上非常有效，尤其是在预防革兰氏阴性菌引起的 VAP 方面。然而，Stoutenbeek 的假设，即局部抗生素研究中的 VAP 发生率取决于研究中对照组和干预组是同期还是非同期的情况，尚未得到验证。搜索了关于局部多粘菌素用于机械通气（MV）患者的呼吸道应用的同期对照（CC）与非同期对照（NCC）设计研究的文献，报告了相关呼吸机相关性肺炎（PsVAP）的发生率。非多粘菌素研究的各种其他干预措施的研究为提供了额外的参考点。使用广义估计方程方法对所有研究的对照组和干预组中的 PsVAP 发生率进行了基准测试。点图、毛毛虫图和漏斗图可实现直观的基准测试。从 102 个观察性研究组得出的 PsVAP 基准值（95%置信区间[CI]）为 4.6%（4.0 至 5.3%）。相比之下，NCC 多粘菌素干预组的平均 PsVAP （1.6%；CI，1.0 至 4.5%）低于所有其他组别的平均值。CC 多粘菌素对照组的平均 PsVAP （9.9%；CI，7.6 至 12.8%）高于所有其他组别的平均值。多粘菌素呼吸道应用研究中对照组和干预组的 PsVAP 发生率取决于这些组是处于同期还是非同期研究中。Stoutenbeek 的同期性假设得到了验证。
