Effects of prophylactic nebulized antibiotics on the prevention of ICU-acquired pneumonia: a systematic review and meta-analysis

Abstract

Objective To evaluate the efficacy and safety of prophylactic nebulized antibiotics in preventing intensive care unit (ICU)-acquired pneumonia through a meta-analysis. Methods Randomized controlled trials (RCTs) investigating the potential reduction in the incidence of ICU-acquired pneumonia through prophylactic nebulized antibiotics were collected by searching the PubMed, Embase, and Cochrane Library databases from their inception to January 23, 2024. The primary endpoint was the incidence of ICU-acquired pneumonia, while the secondary endpoints included mortality, length of ICU stay, mechanical ventilation days, and nebulization-related side effects. Statistical analyses were performed using RevMan 5.3 and STATA 14.0 software. Results A total of six RCTs were included in the analysis, involving 1,287 patients (636 patients in the study group received prophylactic antibiotic therapy, including Polymyxin B, Tobramycin, Ceftazidime, Colistimethate sodium, and amikacin; 651 patients in the control group primarily received saline). The results indicated that prophylactic nebulized antibiotic therapy significantly reduced the incidence of ICU-acquired pneumonia compared to that in the control group (odds ratio (OR) = 0.57, 95% confidence interval (CI) [0.43–0.74], P < 0.0001). No significant difference was observed in the mortality rate between the treatment and control groups (OR = 0.86, 95% CI [0.68–1.10], P = 0.24). Prophylactic nebulized antibiotic therapy also did not significantly reduce the length of ICU stay (MD = 0.2 days; 95% CI [−0.81 to 1.20], P = 0.70) or the number of mechanical ventilation days (MD = 0.43 days; 95% CI [−0.47 to 1.33], P = 0.35). Additionally, there was no evidence that prophylactic nebulized antibiotic therapy contributed to the development of multiple drug-resistant (MDR) bacterial pneumonia or increased the incidence of associated side effects, such as airway spasms. Conclusions This meta-analysis suggests that ICU-acquired pneumonia can be prevented by prophylactic nebulized antibiotic therapy in critically ill patients without increasing the risk of MDR bacterial infections or airway spasms. However, the reduction in the incidence of ICU-acquired pneumonia did not result in significant improvements in mortality or length of ICU stay.

Keywords

• Critically ill patients
• ICU-acquired pneumonia
• Prevention
• Prophylactic nebulized antibiotics
• Mortality rate