Intravenous combined with aerosolised polymyxins vs intravenous polymyxins monotherapy for ventilator-associated pneumonia: A systematic review and meta-analysis.

Autor: Tong R; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: tongransw@163.com., Zou X; Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China. Electronic address: zouxinlei2415@163.com., Shi X; Xinyang Central Hospital, Xinyang 464000, China. Electronic address: 52195649@qq.com., Zhang X; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: emzhxj@126.com., Li X; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: lixiang6263@163.com., Liu S; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: liushaohua3321@163.com., Duan X; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: xiaoguangduan@163.com., Han B; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: hanbingofchina@163.com., Wang H; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: wanghaixu002@126.com., Zhang R; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: zhangruifang312@163.com., Sun L; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: sunxiaominwater@163.com., Kong Y; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: 71335387@qq.com., Zhang F; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: 2937507283@qq.com., Ma M; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: mingyu_ma@hotmail.com., Ding X; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: dingxianfei2009@163.com., Sun T; General Intensive Care Unit, Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Henan Engineering Research Center for Critical Care Medicine, Henan Key Laboratory of Critical Care Medicine, Henan Key Laboratory of Sepsis in Health Commission, Zhengzhou Key Laboratory of Sepsis, Henan Sepsis Diagnosis and Treatment Center, Zhengzhou 450052, China. Electronic address: suntongwen@163.com.
Jazyk: angličtina
Zdroj: International journal of antimicrobial agents [Int J Antimicrob Agents] 2024 Dec; Vol. 64 (6), pp. 107357. Date of Electronic Publication: 2024 Oct 09.
DOI: 10.1016/j.ijantimicag.2024.107357
Abstrakt: Polymyxins were applied via different administration routes to treat ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Gram-negative bacteria (CR-GNB). The potential benefits of aerosolised polymyxins as adjunctive treatment for patients are contradictory. This review assessed the safety and efficacy of intravenous (IV) combined with aerosolised polymyxins vs IV polymyxins monotherapy in patients with VAP caused by CR-GNB. Two reviewers independently evaluated and extracted data from PubMed, Embase, Cochrane library and Web of Science. The primary outcome was all-cause mortality and secondary outcomes included clinical cure rate, clinical improvement rate, microbiological eradication rate and nephrotoxicity. Differences for dichotomous outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Eleven eligible studies were included. The results showed that compared with IV polymyxins monotherapy, IV plus aerosolised polymyxins therapy significantly reduced all-cause mortality rate (OR = 0.75, 95% CI 0.57-0.99, P = 0.045) and improved clinical improvement rate (OR = 1.62, 95% CI 1.02-2.60, P = 0.043) and microbial eradication rate (OR = 2.07, 95% CI 1.40-3.05, P = 0.000). However, there were no significant differences in terms of clinical cure rate (OR = 1.59, 95% CI 0.96-2.63, P = 0.072) and nephrotoxicity (OR = 1.14, 95% CI 0.80-1.63, P = 0.467) for IV plus aerosolised polymyxins therapy. Subgroup analysis revealed that the clinical improvement rate was significantly improved in case-control studies. Aerosolised polymyxins may be a useful adjunct to IV polymyxins for patients with CR-GNB VAP.
Competing Interests: Declarations Funding: This study was supported by the Fund of National Natural Science Foundation of China (Grant No. 82172129, 82202370); General Program of China Postdoctoral Science Foundation (Grant No.2023M733233). Competing Interests: The authors have no conflicts of interest to disclose. Ethical Approval: Not required. Patient Consent: Not applicable.
(Copyright © 2024 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.)
Databáze: MEDLINE
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