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. 2017 Dec;7(1):67.
doi: 10.1186/s13613-017-0291-4. Epub 2017 Jun 15.

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

Cássia Righy  1   2 , Pedro Emmanuel Americano do Brasil  3 , Jordi Vallés  4   5 , Fernando A Bozza  3   6 , Ignacio Martin-Loeches  4   7   8
Affiliations

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

Cássia Righy et al. Ann Intensive Care. 2017 Dec.

Abstract

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.

Keywords: Coma; Meta-analysis; Systematic review; Ventilator-associated pneumonia.

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Figures

Fig. 1
Fig. 1
Selection of studies on antibiotic use for VAP prevention in comatose patients
Fig. 2
Fig. 2
Impact of antibiotic prophylaxis on early VAP, ICU mortality, duration of mechanical ventilation, and ICU length of stay
See this image and copyright information in PMC

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