Carbapenem vs. non-carbapenem antibiotics for ventilator-associated pneumonia: A systematic review with meta-analysis.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Netherlands NLM ID: 101581124 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2212-5353 (Electronic) Linking ISSN: 22125345 NLM ISO Abbreviation: Respir Investig Subsets: MEDLINE
    • Publication Information:
      Original Publication: Amsterdam : Elsevier
    • Subject Terms:
      Pneumonia, Ventilator-Associated*/drug therapy ; Pneumonia, Ventilator-Associated*/microbiology; Humans ; Carbapenems/therapeutic use ; Carbapenems/pharmacology ; Anti-Bacterial Agents/therapeutic use
    • Abstract:
      Background: Carbapenem is recommended as one of the first-line regimens for ventilator-associated pneumonia (VAP), but no recent systematic review has fully investigated its efficacy. This systematic review aims to evaluate the efficacy of carbapenem compared with non-carbapenem for VAP treatment.
      Methods: We performed a systematic review and meta-analysis of studies comparing the efficacy and the safety between carbapenem and non-carbapenem with activity to Pseudomonas aeruginosa in the treatment for VAP. The main outcome was mortality, and the additional outcomes were the clinical cure of pneumonia, length of intensive care unit stay, recurrence, adverse effects, and the development of resistant bacteria. This study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.
      Results: Of the initial 1,730 publications, 9 randomized control trials were enrolled. In the meta-analysis, no difference was observed between the carbapenem and non-carbapenem regimens in improving mortality (odds ratio, 0.83; 95 % confidence interval (CI) 0.67-1.02). While the carbapenem regimen was superior to the non-carbapenem regimen in studies reporting the resolution of pneumonia (odds ratio, 1.09; 95 % CI 1.01-1.17), the effectiveness of carbapenem treatment was not evident in studies assessing the other outcomes.
      Conclusions: Carbapenem might have no superiority in survival when treating VAP. Moreover, non-carbapenem antibiotics with activities to P. aeruginosa have a potential option to avoid inducing carbapenem-resistant pathogens.
      Competing Interests: Declaration of competing interest The authors have no conflicts of interest.
      (Copyright © 2023 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)
    • Contributed Indexing:
      Keywords: Carbapenem; Empiric therapy; Ventilator-associated pneumonia
    • Accession Number:
      0 (Carbapenems)
      0 (Anti-Bacterial Agents)
    • Publication Date:
      Date Created: 20240108 Date Completed: 20240226 Latest Revision: 20240226
    • Publication Date:
      20240226
    • Accession Number:
      10.1016/j.resinv.2023.12.006
    • Accession Number:
      38190794