Short-course versus prolonged-course antibiotic regimens for ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials

Cheema, Huzaifa Ahmad; Ellahi, Aayat; Hussain, Hassan ul; Kashif, Haider; Adil, Mariam; Kumar, Danisha; Shahid, Abia; Ehsan, Muhammad; Singh, Harpreet; Duric, Natalie; Szakmány, Tamás

doi:10.1016/j.jcrc.2023.154346

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…12 A similar metaanalysis with relatively higher proportion of NF-GNB isolates (45.4%) by Cheema et al revealed that while there was no difference in mortality or length of stay, the short course regimen was associated with slightly increased risk of recurrence in NF-GNB VAP. 13 Our study did not have any incidence of recurrence reported among both groups of patients. In this study, infection with resistant pathogens such as A. baumannii, Klebsiella and Pseudomonas species were associated with higher mortality rates (48%, 59% and 33%, respectively) which is similar to global data.…”

Section: Open Accessmentioning

confidence: 49%

“…A recent meta-analysis by Daghmouri et al including five RCTs from the USA, France and Tunisia with a moderate certainty of evidence (GRADE, (Grading of Recommendations, Assessment, Development, and Evaluations)) and low heterogeneity, revealed that there was no significant difference for recurrence and relapse of VAP among those receiving short- and long-course antibiotic therapy (OR=1.48, 95% CI 0.96 to 2.28, p=0.08) 12. A similar meta-analysis with relatively higher proportion of NF-GNB isolates (45.4%) by Cheema et al revealed that while there was no difference in mortality or length of stay, the short course regimen was associated with slightly increased risk of recurrence in NF-GNB VAP 13. Our study did not have any incidence of recurrence reported among both groups of patients.…”

Section: Discussionmentioning

confidence: 92%

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Association of antibiotic duration and all-cause mortality in a prospective study of patients with ventilator-associated pneumonia in a tertiary-level critical care unit in Southern India

Stanley,

Jeevan,

Yadav

et al. 2024

BMJ Open

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ObjectivesTo estimate all-cause mortality in ventilator-associated pneumonia (VAP) and determine whether antibiotic duration beyond 8 days is associated with reduction in all-cause mortality in patients admitted with VAP in the intensive care unit.DesignA prospective cohort study of patients diagnosed with VAP based on the National Healthcare Safety Network definition and clinical criteria.SettingSingle tertiary care hospital in Southern India.Participants100 consecutive adult patients diagnosed with VAP were followed up for 28 days postdiagnosis or until discharge.Outcome measuresThe incidence of mortality at 28 days postdiagnosis was measured. Tests for association and predictors of mortality were determined using χ2test and multivariate Cox regression analysis. Secondary outcomes included baseline clinical parameters such as age, underlying comorbidities as well as measuring total length of stay, number of ventilator-free days and antibiotic-free days.ResultsThe overall case fatality rate due to VAP was 46%. There was no statistically significant difference in mortality rates between those receiving shorter antibiotic duration (5–8 days) and those on longer therapy. Among those who survived until day 9, the observed risk difference was 15.1% between both groups, with an HR of 1.057 (95% CI 0.26 to 4.28). In 70.4% of isolates, non-fermenting Gram-negative bacilli were identified, of which the most common pathogen isolated wasAcinetobacter baumannii(62%).ConclusionIn this hospital-based cohort study, there is insufficient evidence to suggest that prolonging antibiotic duration beyond 8 days in patients with VAP improves survival.

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Section: Open Accessmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 92%

Association of antibiotic duration and all-cause mortality in a prospective study of patients with ventilator-associated pneumonia in a tertiary-level critical care unit in Southern India

Stanley,

Jeevan,

Yadav

et al. 2024

BMJ Open

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“…), при стафилококковой бактериемии, в случае неадекватной или неэффективной стартовой АБТ. В одном из недавних метаанализов риск рецидива при назначении короткого курса АБ оказался также выше при НПИВЛ, ассоциированной с неферментирующими ГОБ [50]. Однако авторы метаанализа обращают внимание на ограниченное количество исследований и невысокое качество имеющихся доказательств.…”

Section: общие принципы абт нпunclassified

Diagnosis and antibiotic therapy of nosocomial pneumonia in adults: from recommendations to real practice. A review

Rachina,

Fedina,

Sukhorukova

et al. 2023

Terapevticheskii arkhiv

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Nosocomial pneumonia is a healthcare-associated infection with significant consequences for the patient and the healthcare system. The efficacy of treatment significantly depends on the timeliness and adequacy of the antibiotic therapy regimen. The growth of resistance of gram-negative pathogens of nosocomial pneumonia to antimicrobial agents increases the risk of prescribing inadequate empirical therapy, which worsens the results of patient treatment. Identification of risk factors for infection with multidrug-resistant microorganisms, careful local microbiological monitoring with detection of resistance mechanisms, implementation of antimicrobial therapy control strategy and use of rational combinations of antibacterial drugs are of great importance. In addition, the importance of using new drugs with activity against carbapenem-resistant strains, including ceftazidime/aviabactam, must be understood. This review outlines the current data on the etiology, features of diagnosis and antibacterial therapy of nosocomial pneumonia.

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“…Patients in the ICU are often critically ill, with shorter survival times and higher mortality rates. In addition, previous studies ( Casale et al., 2023 ; Cheema et al., 2023 ) showed that death in ICU patients infected with gram-negative bacillary pneumonia is related to clinical characteristics and therapeutic measures, but the predictive efficiency of various factors varies greatly, and no effective prediction model for the short-term mortality of these patients exists, nor does an evaluation of their short-term survival time. Thus, there is an important need for predictive models to determine the short-term mortality and survival analysis of ICU patients with gram-negative bacillary pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Risk stratification and survival time of patients with gram-negative bacillary pneumonia in the intensive care unit

Liao,

Feng,

Zhuo

et al. 2024

Front. Cell. Infect. Microbiol.

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IntroductionPneumonia is a common infection in the intensive care unit (ICU), and gram-negative bacilli are the most common bacterial cause. The purpose of the study was to investigate the risk factors for 30-day mortality in patients with gram-negative bacillary pneumonia in the ICU, construct a predictive model, and stratify patients based on risk to assess their short-term survival.MethodsPatients admitted to the ICU with gram-negative bacillary pneumonia at Fujian Medical University Affiliated First Hospital between January 2018 and September 2020 were selected. Patients were divided into deceased and survivor groups based on whether death occurred within 30 days. Multifactorial logistic regression analysis was used to identify independent risk factors for 30-day mortality in these patients, and a predictive nomogram model was constructed based on these factors. Patients were categorized into low-, medium-, and high-risk groups according to the model's predicted probability, and Kaplan-Meier survival curves were plotted to assess short-term survival.ResultsThe study included 305 patients. Lactic acid (odds ratio [OR], 1.524, 95% CI: 1.057-2.197), tracheal intubation (OR: 4.202, 95% CI: 1.092-16.169), and acute kidney injury (OR:4.776, 95% CI: 1.632-13.978) were identified as independent risk factors for 30-day mortality. A nomogram prediction model was established based on these three factors. Internal validation of the model showed a Hosmer-Lemeshow test result of X2=5.770, P=0.834, and an area under the ROC curve of 0.791 (95% CI: 0.688-0.893). Bootstrap resampling of the original data 1000 times yielded a C-index of 0.791, and a decision curve analysis indicated a high net benefit when the threshold probability was between 15%-90%. The survival time for low-, medium-, and high-risk patients was 30 (30, 30), 30 (16.5, 30), and 17 (11, 27) days, respectively, which were significantly different.ConclusionLactic acid, tracheal intubation, and acute kidney injury were independent risk factors for 30-day mortality in patients in the ICU with gram-negative bacillary pneumonia. The predictive model constructed based on these factors showed good predictive performance and helped assess short-term survival, facilitating early intervention and treatment.

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Short-course versus prolonged-course antibiotic regimens for ventilator-associated pneumonia: A systematic review and meta-analysis of randomized controlled trials

Cited by 6 publications

References 23 publications

Association of antibiotic duration and all-cause mortality in a prospective study of patients with ventilator-associated pneumonia in a tertiary-level critical care unit in Southern India

Association of antibiotic duration and all-cause mortality in a prospective study of patients with ventilator-associated pneumonia in a tertiary-level critical care unit in Southern India

Diagnosis and antibiotic therapy of nosocomial pneumonia in adults: from recommendations to real practice. A review

Risk stratification and survival time of patients with gram-negative bacillary pneumonia in the intensive care unit

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