Aerosolized aminoglycoside antibiotics in the treatment of ventilator-associated pneumonia: a meta-analysis_West China Medical Journal

Authors：

HUANG Jizhen ¹ ,  FAN Hong ¹ , ZHANG Yonggang ^2,3 , TONG Xiang ¹

1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Chinese Evidence-based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

FAN Hong, Email: fanhongfan@qq.com

Keywords：

Aminoglycoside antibiotics; Aerosol inhalation; Ventilator-associated pneumonia; Meta-analysis

DOI：

10.7507/1002-0179.201901048

Video：

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ObjectiveTo evaluate the efficacy of aerosolized aminoglycoside antibiotics in patients with ventilator-associated pneumonia (VAP) by meta-analysis.MethodsWe searched PubMed, Embase, China National Knowledge Infrastructure, VIP and Wanfang Data for the Chinese and English literature on aerosolized aminoglycoside antibiotics for VAP until May, 2018. After data extraction and quality evaluation, RevMan 5.2 software was performed for meta-analysis.ResultsA total of 9 randomized controlled trials and a total of 543 patients were included in this study. Compared with patients treated with non-atomized inhaled aminoglycoside antibiotics, meta-analysis showed that aerosol inhalation of amikacin significantly improved the clinical cure rate of patients with VAP ［odds ratio (OR)=2.37, 95% confidence interval (CI) (1.50, 3.75), P=0.000 2］, nebulized tobramycin ［OR=2.30, 95%CI (0.92, 5.78), P=0.08］ and two or more antibiotics ［OR=2.00, 95%CI (0.62, 6.46), P=0.25］ had no significant effect on the clinical cure rate of patients with VAP; aerosolized aminoglycoside antibiotics had no significant effect on mortality of patients ［OR=1.17, 95%CI (0.66, 2.07), P=0.59］ and tracheal spasm rate ［OR=2.39, 95%CI (0.94, 6.11), P=0.07］ and renal dysfunction rate ［OR=0.62, 95%CI (0.32, 1.21), P=0.16］ in patients with VAP.ConclusionInhalation of amikacin can significantly improve the clinical cure rate of patients with VAP, but it can not reduce the mortality rate of patients; the safety of aerosolized aminoglycoside antibiotics is good, and the risk of tracheal spasm and renal function damage in patients with VAP is not increased.

Citation： HUANG Jizhen, FAN Hong, ZHANG Yonggang, TONG Xiang. Aerosolized aminoglycoside antibiotics in the treatment of ventilator-associated pneumonia: a meta-analysis. West China Medical Journal, 2019, 34(1): 58-65. doi: 10.7507/1002-0179.201901048 Copy

1.	Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Critical Care, 2014, 18(2): 208.
2.	Barbier F, Andremont A, Wolff M, et al. Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med, 2013, 19(3): 216-228.
3.	Afify MH, Shaheen EA, El-Dahdouh SS, et al. Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP. Egypt J Chest Dis Tuberc, 2016, 65(1): 113-119.
4.	Flume PA, VanDevanter DR. Clinical applications of pulmonary delivery of antibiotics. Adv Drug Deliv Rev, 2015, 85: 1-6.
5.	李虎, 杨春辉, 薛杨勇, 等. 雾化吸入阿米卡星治疗铜绿假单胞菌引起的呼吸机相关性肺炎的临床观察. 内科急危重症杂志, 2016, 22(5): 335-337.
6.	Liu C, Zhang YT, Peng ZY, et al. Aerosolized amikacin as adjunctive therapy of ventilator-associated pneumonia caused by multidrug-resistant gram-negative bacteria: a single-center randomized controlled trial. Chin Med J (Engl), 2017, 130(10): 1196-1201.
7.	岳新召. 雾化吸入阿米卡星治疗呼吸机相关性肺炎的疗效及可行性研究. 临床合理用药杂志, 2016, 9(15): 38-39, 42.
8.	王昕华, 赵弘卿. 抗生素不同给药方式治疗呼吸机相关性肺炎的临床观察. 中国药业, 2015, 24(23): 46-48.
9.	李虎, 杨春辉, 薛杨勇, 等. 雾化吸入抗生素治疗呼吸机相关性肺炎的临床疗效观察. 中国呼吸与危重监护杂志, 2015, 14(3): 273-277.
10.	刘建民, 郭奕芬. 雾化吸入妥布霉素联合静脉使用抗生素治疗呼吸机相关性肺炎的疗效. 实用临床医学, 2015, 16(9): 20-21.
11.	Niederman MS, Chastre J, Corkery K, et al. BAY41-6551 achieves bactericidal tracheal aspirate amikacin concentrations in mechanically ventilated patients with gram-negative pneumonia. Intensive Care Medicine, 2012, 38(2): 263-271.
12.	Hallal A, Cohn SM, Namias N, et al. Aerosolized tobramycin in the treatment of ventilator-associated pneumonia: a pilot study. Surg Infect (Larchmt), 2007, 8(1): 73-82.
13.	Le Conte P, Potel G, Clémenti E, et al. Administration of tobramycin aerosols in patients with nosocomial pneumonia: a preliminary study. Presse Médicale, 2000, 29(2): 76-78.
14.	Kalil AC, Metersky ML, Klompas M, et al. Executive summary: management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): 575-582.
15.	Ekren PK, Ranzani OT, Ceccato A, et al. Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multidrug-Resistant Pathogens in Patients with Hospital-acquired and Ventilator-associated Pneumonia in the ICU. Am J Respir Crit Care Med, 2018, 197(6): 826-830.
16.	杨春辉, 李虎, 薛杨勇, 等. 雾化吸入阿米卡星气道分泌物及血药动力学特点. 内科急危重症杂志, 2013, 19(3): 165-167.

1. Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Critical Care, 2014, 18(2): 208.
2. Barbier F, Andremont A, Wolff M, et al. Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med, 2013, 19(3): 216-228.
3. Afify MH, Shaheen EA, El-Dahdouh SS, et al. Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP. Egypt J Chest Dis Tuberc, 2016, 65(1): 113-119.
4. Flume PA, VanDevanter DR. Clinical applications of pulmonary delivery of antibiotics. Adv Drug Deliv Rev, 2015, 85: 1-6.
5. 李虎, 杨春辉, 薛杨勇, 等. 雾化吸入阿米卡星治疗铜绿假单胞菌引起的呼吸机相关性肺炎的临床观察. 内科急危重症杂志, 2016, 22(5): 335-337.
6. Liu C, Zhang YT, Peng ZY, et al. Aerosolized amikacin as adjunctive therapy of ventilator-associated pneumonia caused by multidrug-resistant gram-negative bacteria: a single-center randomized controlled trial. Chin Med J (Engl), 2017, 130(10): 1196-1201.
7. 岳新召. 雾化吸入阿米卡星治疗呼吸机相关性肺炎的疗效及可行性研究. 临床合理用药杂志, 2016, 9(15): 38-39, 42.
8. 王昕华, 赵弘卿. 抗生素不同给药方式治疗呼吸机相关性肺炎的临床观察. 中国药业, 2015, 24(23): 46-48.
9. 李虎, 杨春辉, 薛杨勇, 等. 雾化吸入抗生素治疗呼吸机相关性肺炎的临床疗效观察. 中国呼吸与危重监护杂志, 2015, 14(3): 273-277.
10. 刘建民, 郭奕芬. 雾化吸入妥布霉素联合静脉使用抗生素治疗呼吸机相关性肺炎的疗效. 实用临床医学, 2015, 16(9): 20-21.
11. Niederman MS, Chastre J, Corkery K, et al. BAY41-6551 achieves bactericidal tracheal aspirate amikacin concentrations in mechanically ventilated patients with gram-negative pneumonia. Intensive Care Medicine, 2012, 38(2): 263-271.
12. Hallal A, Cohn SM, Namias N, et al. Aerosolized tobramycin in the treatment of ventilator-associated pneumonia: a pilot study. Surg Infect (Larchmt), 2007, 8(1): 73-82.
13. Le Conte P, Potel G, Clémenti E, et al. Administration of tobramycin aerosols in patients with nosocomial pneumonia: a preliminary study. Presse Médicale, 2000, 29(2): 76-78.
14. Kalil AC, Metersky ML, Klompas M, et al. Executive summary: management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the infectious diseases society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): 575-582.
15. Ekren PK, Ranzani OT, Ceccato A, et al. Evaluation of the 2016 Infectious Diseases Society of America/American Thoracic Society Guideline Criteria for Risk of Multidrug-Resistant Pathogens in Patients with Hospital-acquired and Ventilator-associated Pneumonia in the ICU. Am J Respir Crit Care Med, 2018, 197(6): 826-830.
16. 杨春辉, 李虎, 薛杨勇, 等. 雾化吸入阿米卡星气道分泌物及血药动力学特点. 内科急危重症杂志, 2013, 19(3): 165-167.

West China Medical Journal

Aerosolized aminoglycoside antibiotics in the treatment of ventilator-associated pneumonia: a meta-analysis

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