PMID- 36911269
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230314
IS  - 2589-5370 (Electronic)
IS  - 2589-5370 (Linking)
VI  - 58
DP  - 2023 Apr
TI  - Comparison of a short versus long-course antibiotic therapy for 
      ventilator-associated pneumonia: a systematic review and meta-analysis of 
      randomized controlled trials.
PG  - 101880
LID - 10.1016/j.eclinm.2023.101880 [doi]
LID - 101880
AB  - BACKGROUND: For ventilator-associated pneumonia (VAP), the safety of short-course 
      versus long-course antibiotic therapy is still debated, especially regarding 
      documented VAP due to non-fermenting Gram-negative bacilli (NF-GNB). The aim of 
      this meta-analysis was to assess the rates of recurrence and relapse of VAP in 
      patients receiving short-course (</=8 days) and long-course (>/=10-15 days) of 
      antibiotic therapy. METHODS: The protocol for this study was registered in the 
      PROSPERO database (ID: CRD42022365138). We performed an electronic search of the 
      relevant literature and limited our search to data published from 2000 until 
      September 1, 2022. We searched for randomized controlled trials (RCTs) in the 
      United States National Library of Medicine, Cochrane Database of Systematic 
      Reviews (CDSR) and the Cochrane Central Register of Controlled Trials (CENTRAL), 
      Embase, National Institutes of Health PubMed/MEDLINE, web of science and Google 
      Scholar databases. The primary endpoint was the recurrence and relapses of VAP, 
      secondary endpoints were 28-day mortality, mechanical ventilation duration, 
      number of extra-pulmonary infections and length of ICU stay. FINDINGS: We 
      identified five relevant studies involving 1069 patients (530 patients in the 
      short-course group and 539 patients in the long-course group). The meta-analysis 
      did not reveal any significant difference between short and long-course 
      antibiotic therapy for recurrence and relapses of VAP (odd ratio "OR" = 1.48, 95% 
      confidence intervals (CI) [0.96, 2.28], p = 0.08 and OR = 1.45, 95% CI [0.94, 
      2.22], p = 0.09, respectively), including those due to NF-GNB (OR = 1.90, 95% CI 
      [0.93, 3.33], p = 0.05 and OR = 1.76, 95% CI [0.93, 3.33], p = 0.08, 
      respectively). No difference was found for 28 days-mortality (OR = 1.24, 95% CI 
      [0.92, 1.67], p = 0.16), mechanical ventilation duration, number of 
      extra-pulmonary infections and length of ICU stay. However, short-course therapy 
      significantly increased the number of antibiotic-free days. INTERPRETATION: Our 
      meta-analysis showed that short-course antibiotic therapy did not result in 
      increased number of recurence and relapses of VAP, suggesting that short-course 
      should be preferred to reduce the exposure to antibiotics. FUNDING: None.
CI  - (c) 2023 The Author(s).
FAU - Daghmouri, Mohamed Aziz
AU  - Daghmouri MA
AD  - Department of Anesthesiology, Critical Care and Burn Unit, University Hospital 
      Saint-Louis-Lariboisiere, AP-HP, Paris, France.
FAU - Dudoignon, Emmanuel
AU  - Dudoignon E
AD  - Department of Anesthesiology, Critical Care and Burn Unit, University Hospital 
      Saint-Louis-Lariboisiere, AP-HP, Paris, France.
AD  - INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite 
      de Paris Cite, Paris, France.
AD  - Universite de Paris Cite, Paris, France.
FAU - Chaouch, Mohamed Ali
AU  - Chaouch MA
AD  - Department of Visceral Surgery, University Hospital of Fattouma Bourguiba, 
      Monastir, Tunisia.
FAU - Baekgaard, Josefine
AU  - Baekgaard J
AD  - Department of Anesthesiology, Critical Care and Burn Unit, University Hospital 
      Saint-Louis-Lariboisiere, AP-HP, Paris, France.
FAU - Bougle, Adrien
AU  - Bougle A
AD  - Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, 
      Sorbonne University, GRC 29, AP-HP, Pitie-Salpetriere Hospital, Paris, France.
FAU - Leone, Marc
AU  - Leone M
AD  - Service d'anesthesie et de Reanimation, Hopital Nord, Assistance Publique 
      Hopitaux de Marseille, Aix Marseille Universite, Marseille, France.
AD  - Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, 
      Aix Marseille University, Marseille, France.
FAU - Deniau, Benjamin
AU  - Deniau B
AD  - Department of Anesthesiology, Critical Care and Burn Unit, University Hospital 
      Saint-Louis-Lariboisiere, AP-HP, Paris, France.
AD  - INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite 
      de Paris Cite, Paris, France.
AD  - Universite de Paris Cite, Paris, France.
AD  - Department of Visceral Surgery, University Hospital of Fattouma Bourguiba, 
      Monastir, Tunisia.
FAU - Depret, Francois
AU  - Depret F
AD  - Department of Anesthesiology, Critical Care and Burn Unit, University Hospital 
      Saint-Louis-Lariboisiere, AP-HP, Paris, France.
AD  - INSERM UMR-S 942, Cardiovascular Markers in Stress Condition (MASCOT), Universite 
      de Paris Cite, Paris, France.
AD  - Universite de Paris Cite, Paris, France.
LA  - eng
PT  - Journal Article
DEP - 20230301
PL  - England
TA  - EClinicalMedicine
JT  - EClinicalMedicine
JID - 101733727
PMC - PMC9995933
OTO - NOTNLM
OT  - Antibiotic duration
OT  - Gram-negative bacilli
OT  - Meta-analysis
OT  - Recurrence
OT  - Systematic review
OT  - Ventilator-associated pneumonia
COIS- The authors declare that they have no conflict of interest.
EDAT- 2023/03/14 06:00
MHDA- 2023/03/14 06:01
PMCR- 2023/03/01
CRDT- 2023/03/13 04:24
PHST- 2022/12/19 00:00 [received]
PHST- 2023/02/03 00:00 [revised]
PHST- 2023/02/03 00:00 [accepted]
PHST- 2023/03/13 04:24 [entrez]
PHST- 2023/03/14 06:00 [pubmed]
PHST- 2023/03/14 06:01 [medline]
PHST- 2023/03/01 00:00 [pmc-release]
AID - S2589-5370(23)00057-3 [pii]
AID - 101880 [pii]
AID - 10.1016/j.eclinm.2023.101880 [doi]
PST - epublish
SO  - EClinicalMedicine. 2023 Mar 1;58:101880. doi: 10.1016/j.eclinm.2023.101880. 
      eCollection 2023 Apr.