Prophylactic antibiotic for preventing ventilator-associated pneumonia: a pairwise and Bayesian network meta-analysis

Abstract

Abstract Background The role of prophylactic antibiotics in preventing ventilator-associated pneumonia (VAP) for patients undergoing invasive mechanical ventilation (IMV) remains unclear. This network meta-analysis aimed to compare the efficacy and safety of antibiotic prophylaxis in preventing VAP for IMV population in intensive care unit (ICU). Methods We searched the PubMed, Web of Science, Embase and Cochrane Library databases from inception to December 2021, to identify relevant studies assessing the impact of prophylactic antibiotics on the incidence of VAP, mortality, the duration of ICU stays and hospitalization to perform a meta-analysis. Results Thirteen studies (2144 patients) were included, twelve of which selected for primary analysis revealed that prophylactic antibiotics resulted in a lower VAP rate compared with control groups (risk ratio [RR] = 0.62). Bayesian network meta-analysis found that aerosolized tobramycin and intravenous ampicillin-sulbactam presented the greatest likelihood to be most efficient regimen for reducing VAP. Conclusions Antibiotic prophylaxis may reduce the incidence of VAP, but not mortality, for adult patients undergoing IMV in ICUs. Tobramycin via nebulization and ampicillin-sulbactam via intravenous administration presented the greatest likelihood to be most efficient regimen for preventing VAP. However, well-designed randomized studies are warranted to make definite recommendations.