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Original ResearchCritical CareFeaturedShort- vs Long-Duration Antibiotic Regimens for Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis
Section snippets
Data Sources
Two independent reviewers performed the literature search in PubMed until November 15, 2012 and the Cochrane Central Register of Controlled Trials. Also, the bibliographies of evaluable studies were hand searched. The search terms used were “VAP,” “ventilator-associated pneumonia,” “short,” “long,” “duration,” “course,” “treatment,” and “therapy.” The same two reviewers performed the evaluation of papers that were potentially eligible for inclusion as well as the extraction of data. Any
Study Selection Process
A flow diagram of the screening and selection of articles to be included in the meta-analysis is presented in Figure 1. We identified 843 and 85 potentially evaluable trials from PubMed and Cochrane Central Register of Controlled Trials, respectively. Of those, four RCTs were eventually included in the meta-analysis.20, 21, 22, 23
Study Characteristics
The main characteristics of the included RCTs are presented in Table 1. Three of four of the included RCTs were multicenter,20, 23 and the remaining RCT was
Discussion
The main finding of our meta-analysis was that short-course (7-8 days) treatment of VAP had no difference in terms of mortality compared with long-course (10-15 days) treatment. Short-course treatment was associated with increased antibiotic-free days compared with long-course treatment. No difference was found regarding relapses between the compared arms, although a marginally nonsignificant trend to lower relapses in the long-course treatment was observed.
Although data regarding the first two
Conclusions
Conclusively, short-course antibiotic treatment had no difference in terms of mortality compared with long-course regimens for the treatment of patients with VAP. It was associated with increased antibiotic-free days and had no difference in terms of relapses, although there was a trend in favor of long-course treatment, which is attributed to nonfermentative gram-negative bacilli as causative pathogens of VAP. Further trials are warranted to shed light on the issue of optimizing duration of
Acknowledgments
Author contributions: Dr Matthaiou is the guarantor of the content of the manuscript, including the data and analysis.
Dr Dimopoulos: contributed to conceiving and designing the meta-analysis, revised the article critically for important intellectual content, and provided final approval of the version to be published.
Dr Poulakou: contributed to acquiring, analyzing, and interpreting the data; revised the article critically for important intellectual content; and provided final approval of the
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2022, Emergency Medicine Clinics of North AmericaCitation Excerpt :However, a subgroup of patients with non-lactose fermenting pathogens (eg, P aeruginosa) had a higher rate of recurrent infections, which was confirmed in one meta-analysis.18,19 Updated meta-analyses of HAP/VAP treatment duration did not show a significant difference in recurrent infections with shorter courses regardless of the causative pathogen.11,20 Ultimately, clinical criteria should guide HAP/VAP resolution and antimicrobial discontinuation.
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.
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