| Title |
Nebulized antibiotics for ventilator-associated pneumonia: a systematic review and meta-analysis
|
|---|---|
| Published in |
Critical Care, December 2015
|
| DOI | 10.1186/s13054-015-0868-y |
| Pubmed ID | |
| Authors |
Fernando G Zampieri, Antonio P Nassar Jr, Dimitri Gusmao-Flores, Leandro U Taniguchi, Antoni Torres, Otavio T Ranzani |
| Abstract |
Nebulized antibiotics are a promising new treatment option for ventilator-associated pneumonia (VAP). However, more evidence of the benefit of this therapy is desired. The Medline, Scopus, EMBASE, Biological Abstracts, CAB Abstracts, Food Science and Technology Abstracts, CENTRAL, Scielo and Lilacs databases were searched to identify randomized controlled trials or matched observational studies that compared nebulized antibiotics with or without intravenous antibiotics to intravenous antibiotics alone for VAP treatment. Two reviewers independently collected data and assessed outcomes and risk of bias. The primary outcome was clinical cure. Secondary outcomes were microbiological cure, ICU and hospital mortality, duration of mechanical ventilation, ICU length of stay and adverse events. A mixed-effect model meta-analysis was performed. Trial sequential analysis was used for the main outcome of interest. Twelve studies were analyzed, including six randomized controlled trials. For the main outcome analysis, 812 patients were included. Nebulized antibiotics were associated with higher rates of clinical cure (risk ratio (RR) = 1.23; 95% confidence interval (CI), 1.05-1.43; I(2) = 34%; D(2) = 45%). Nebulized antibiotics were not associated with microbiological cure (RR = 1.24; 95% CI, 0.95-1.62; I(2) = 62.5), mortality (RR = 0.90; CI 95%, 0.76-1.08; I(2) = 0%), duration of mechanical ventilation (standardized mean difference = -0.10 days; 95% CI, -1.22 to 1.00; I(2) = 96.5%), ICU length of stay (standardized mean difference (SMD) = 0.14 days; 95% CI, -0.46 to 0.73; I(2) = 89.2%) or renal toxicity (RR = 1.05; 95% CI, 0.70 to 1.57; I(2) = 15.6%). Regarding the primary outcome, the number of patients included was below the information size required for a definitive conclusion by trial sequential analysis; therefore, our results regarding this parameter are inconclusive. Nebulized antibiotics seem to be associated with higher rates of clinical cure in the treatment of VAP. However, the apparent benefit in the clinical cure rate observed by traditional meta-analysis does not persist after trial sequential analysis. Additional high-quality studies on this subject are highly warranted. CRD42014009116 . Registered 29 March 2014. |
X Demographics
The data shown below were collected from the profiles of 28 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Spain | 5 | 18% |
| France | 3 | 11% |
| United States | 2 | 7% |
| Puerto Rico | 2 | 7% |
| Brazil | 1 | 4% |
| El Salvador | 1 | 4% |
| Ecuador | 1 | 4% |
| Denmark | 1 | 4% |
| United Kingdom | 1 | 4% |
| Other | 0 | 0% |
| Unknown | 11 | 39% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 16 | 57% |
| Practitioners (doctors, other healthcare professionals) | 8 | 29% |
| Scientists | 3 | 11% |
| Science communicators (journalists, bloggers, editors) | 1 | 4% |
Mendeley readers
The data shown below were compiled from readership statistics for 191 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Mexico | 2 | 1% |
| Spain | 2 | 1% |
| Brazil | 2 | 1% |
| Unknown | 185 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Postgraduate | 24 | 13% |
| Student > Master | 20 | 10% |
| Student > Bachelor | 18 | 9% |
| Researcher | 17 | 9% |
| Student > Ph. D. Student | 15 | 8% |
| Other | 55 | 29% |
| Unknown | 42 | 22% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 91 | 48% |
| Pharmacology, Toxicology and Pharmaceutical Science | 15 | 8% |
| Agricultural and Biological Sciences | 7 | 4% |
| Nursing and Health Professions | 6 | 3% |
| Immunology and Microbiology | 3 | 2% |
| Other | 17 | 9% |
| Unknown | 52 | 27% |
Attention Score in Context
This research output has an Altmetric Attention Score of 25. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 August 2023.
All research outputs
#1,549,719
of 25,522,520 outputs
Outputs from Critical Care
#1,365
of 6,578 outputs
Outputs of similar age
#25,442
of 396,288 outputs
Outputs of similar age from Critical Care
#98
of 466 outputs
Altmetric has tracked 25,522,520 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 93rd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,578 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.8. This one has done well, scoring higher than 79% of its peers.
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We're also able to compare this research output to 466 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 79% of its contemporaries.