Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
State Key Laboratory of Respiratory Disease, Guangzhou, China.
Crit Care. 2018 Nov 15;22(1):301. doi: 10.1186/s13054-018-2106-x.
Aerosolized antibiotics have been proposed as a novel and promising treatment option for the treatment of ventilator-associated pneumonia (VAP). However, the optimum aerosolized antibiotics for VAP remain uncertain.
We included studies from two systematic reviews and searched PubMed, EMBASE, and Cochrane databases for other studies. Eligible studies included randomized controlled trials and observational studies. Extracted data were analyzed by pairwise and network meta-analysis.
Eight observational and eight randomized studies were identified for this analysis. By pairwise meta-analysis using intravenous antibiotics as the reference, patients treated with aerosolized antibiotics were associated with significantly higher rates of clinical recovery (risk ratio (RR) 1.21, 95% confidence interval (CI) 1.09-1.34; P = 0.001) and microbiological eradication (RR 1.42, 95% CI 1.22-1.650; P < 0.0001). There were no significant differences in the risks of mortality (RR 0.88, 95% CI 0.74-1.04; P = 0.127) or nephrotoxicity (RR 1.00, 95% CI 0.72-1.39; P = 0.995). Using network meta-analysis, clinical recovery benefits were seen only with aerosolized tobramycin and colistin (especially tobramycin), and microbiological eradication benefits were seen only with colistin. Aerosolized tobramycin was also associated with significantly lower mortality when compared with aerosolized amikacin and colistin and intravenous antibiotics. The assessment of rank probabilities indicated aerosolized tobramycin presented the greatest likelihood of having benefits for clinical recovery and mortality, and aerosolized colistin presented the best benefits for microbiological eradication.
Aerosolized antibiotics appear to be a useful treatment for VAP with respect to clinical recovery and microbiological eradication, and do not increase mortality or nephrotoxicity risks. Our network meta-analysis in patients with VAP suggests that clinical recovery benefits are associated with aerosolized tobramycin and colistin (especially tobramycin), microbiological eradication with aerosolized colistin, and survival with aerosolized tobramycin, mostly based on observational studies. Due to the low levels of evidence, definitive recommendations cannot be made before additional, large randomized studies are carried out.
雾化抗生素已被提议作为治疗呼吸机相关性肺炎 (VAP) 的一种新颖且有前途的治疗选择。然而，VAP 的最佳雾化抗生素仍不确定。
我们纳入了两项系统评价中的研究，并在 PubMed、EMBASE 和 Cochrane 数据库中检索了其他研究。合格的研究包括随机对照试验和观察性研究。提取的数据通过两两和网络荟萃分析进行分析。
本分析共纳入了 8 项观察性研究和 8 项随机研究。通过使用静脉内抗生素作为参照的两两荟萃分析，接受雾化抗生素治疗的患者临床康复率显著提高（风险比 (RR) 1.21，95%置信区间 [CI] 1.09-1.34；P=0.001）和微生物学清除率（RR 1.42，95%CI 1.22-1.650；P<0.0001）。死亡率（RR 0.88，95%CI 0.74-1.04；P=0.127）或肾毒性（RR 1.00，95%CI 0.72-1.39；P=0.995）的风险无显著差异。通过网络荟萃分析，仅观察到雾化妥布霉素和粘菌素（尤其是妥布霉素）具有临床康复益处，且仅观察到雾化粘菌素具有微生物学清除益处。与雾化阿米卡星和粘菌素以及静脉内抗生素相比，雾化妥布霉素也与死亡率显著降低相关。等级概率评估表明，雾化妥布霉素在临床康复和死亡率方面最有可能带来益处，而雾化粘菌素在微生物学清除方面最有益处。
雾化抗生素在 VAP 治疗方面似乎是一种有用的治疗方法，因为它可以提高临床康复和微生物学清除率，且不会增加死亡率或肾毒性风险。我们对 VAP 患者进行的网络荟萃分析表明，临床康复益处与雾化妥布霉素和粘菌素（尤其是妥布霉素）相关，微生物学清除与雾化粘菌素相关，生存与雾化妥布霉素相关，主要基于观察性研究。由于证据水平较低，在进行更多大型随机研究之前，不能做出明确的推荐。
Zotero 插件
