{"title":"β-内酰胺抗生素预防昏迷患者呼吸机相关性肺炎（VAP）：随机对照试验的系统回顾和荟萃分析","authors":"Edinson Dante Meregildo-Rodriguez, Mariano Ortiz-Pizarro, Martha Genara Asmat-Rubio, Carlos Geraldo Fernandez-Narváez, Gustavo Adolfo Vásquez-Tirado","doi":"10.1016/j.medine.2025.502199","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of parenteral β-lactam antibiotics on outcomes related to ventilator-associated pneumonia (VAP) in adult patients in coma due to acute brain injury (ABI).</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting: </strong>Randomized controlled trials (RCTs) published up toSeptember 30, 2024.</p><p><strong>Patients or participants: </strong>Adult patients in coma due to ABI.</p><p><strong>Interventions: </strong>Parenteral β-lactam antibiotics.</p><p><strong>Main variables of interest: </strong>Incidence and outcomes related to VAP.</p><p><strong>Results: </strong>Three RCTs involving 483 patients met inclusion criteria; 231 patients received β-lactam prophylaxis. Among these, there were 115 cases of early-onset VAP (EO-VAP), 49 of late-onset VAP (LO-VAP), and 102 deaths. All studies were conducted in Europe. Causes of coma included trauma, stroke, and CO poisoning. Intravenous β-lactams (ampicillin/sulbactam, cefuroxime, and ceftriaxone) reduced EO-VAP risk by 57% (RR 0.43; 95% CI 0.30-0.61), and all-VAP by 35% (RR 0.65; 95% CI 0.53-0.80). No impact was observed on LO-VAP (RR 0.95; 95% CI 0.54-1.67), 28-day mortality (RR 0.76; 95% CI 0.53-1.09), intubation duration (SMD -0.13; 95% CI -0.46-0.21), or ICU length of stay (SMD -0.22; 95% CI -0.55-0.12). Heterogeneity and the risk of bias were low, with high overall evidence certainty.</p><p><strong>Conclusions: </strong>In adult patients in coma due to ABI, intravenous β-lactam antibiotics reduce EO-VAP and all-VAP risk.</p>","PeriodicalId":94139,"journal":{"name":"Medicina intensiva","volume":" ","pages":"502199"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"β-lactam antibiotics to prevent ventilator-associated pneumonia (VAP) in coma patients: A systematic review and meta-analysis of randomized controlled trials.\",\"authors\":\"Edinson Dante Meregildo-Rodriguez, Mariano Ortiz-Pizarro, Martha Genara Asmat-Rubio, Carlos Geraldo Fernandez-Narváez, Gustavo Adolfo Vásquez-Tirado\",\"doi\":\"10.1016/j.medine.2025.502199\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the effect of parenteral β-lactam antibiotics on outcomes related to ventilator-associated pneumonia (VAP) in adult patients in coma due to acute brain injury (ABI).</p><p><strong>Design: </strong>Systematic review and meta-analysis.</p><p><strong>Setting: </strong>Randomized controlled trials (RCTs) published up toSeptember 30, 2024.</p><p><strong>Patients or participants: </strong>Adult patients in coma due to ABI.</p><p><strong>Interventions: </strong>Parenteral β-lactam antibiotics.</p><p><strong>Main variables of interest: </strong>Incidence and outcomes related to VAP.</p><p><strong>Results: </strong>Three RCTs involving 483 patients met inclusion criteria; 231 patients received β-lactam prophylaxis. Among these, there were 115 cases of early-onset VAP (EO-VAP), 49 of late-onset VAP (LO-VAP), and 102 deaths. All studies were conducted in Europe. Causes of coma included trauma, stroke, and CO poisoning. Intravenous β-lactams (ampicillin/sulbactam, cefuroxime, and ceftriaxone) reduced EO-VAP risk by 57% (RR 0.43; 95% CI 0.30-0.61), and all-VAP by 35% (RR 0.65; 95% CI 0.53-0.80). No impact was observed on LO-VAP (RR 0.95; 95% CI 0.54-1.67), 28-day mortality (RR 0.76; 95% CI 0.53-1.09), intubation duration (SMD -0.13; 95% CI -0.46-0.21), or ICU length of stay (SMD -0.22; 95% CI -0.55-0.12). Heterogeneity and the risk of bias were low, with high overall evidence certainty.</p><p><strong>Conclusions: </strong>In adult patients in coma due to ABI, intravenous β-lactam antibiotics reduce EO-VAP and all-VAP risk.</p>\",\"PeriodicalId\":94139,\"journal\":{\"name\":\"Medicina intensiva\",\"volume\":\" \",\"pages\":\"502199\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medicina intensiva\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.medine.2025.502199\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicina intensiva","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.medine.2025.502199","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：探讨β-内酰胺类抗生素对成人急性脑损伤（ABI）昏迷患者呼吸机相关性肺炎（VAP）预后的影响。设计：系统回顾和荟萃分析。环境：随机对照试验（rct），截止到2024年9月30日。患者或参与者：因ABI而昏迷的成年患者。干预措施：肠外β-内酰胺类抗生素。主要感兴趣的变量：与VAP相关的发病率和预后。结果：3项rct共纳入483例患者，符合纳入标准；231例患者接受β-内酰胺预防治疗。早发型VAP 115例（EO-VAP），晚发型VAP 49例（LO-VAP），死亡102例。所有的研究都在欧洲进行。昏迷的原因包括外伤、中风和一氧化碳中毒。静脉注射β-内酰胺类药物（氨苄西林/舒巴坦、头孢呋辛和头孢曲松）可降低57%的EO-VAP风险(RR 0.43；95% CI 0.30-0.61)， all-VAP降低35% (RR 0.65；95% ci 0.53-0.80)。对LO-VAP无影响(RR 0.95；95% CI 0.54-1.67)， 28天死亡率(RR 0.76；95% CI 0.53-1.09)、插管时间(SMD -0.13；95% CI -0.46-0.21)或ICU住院时间(SMD -0.22；95% ci -0.55-0.12)。异质性和偏倚风险较低，总体证据确定性较高。结论：在ABI致昏迷的成人患者中，静脉注射β-内酰胺类抗生素可降低EO-VAP和all-VAP的风险。
β-lactam antibiotics to prevent ventilator-associated pneumonia (VAP) in coma patients: A systematic review and meta-analysis of randomized controlled trials.
Objective: To evaluate the effect of parenteral β-lactam antibiotics on outcomes related to ventilator-associated pneumonia (VAP) in adult patients in coma due to acute brain injury (ABI).
Design: Systematic review and meta-analysis.
Setting: Randomized controlled trials (RCTs) published up toSeptember 30, 2024.
Patients or participants: Adult patients in coma due to ABI.
Interventions: Parenteral β-lactam antibiotics.
Main variables of interest: Incidence and outcomes related to VAP.
Results: Three RCTs involving 483 patients met inclusion criteria; 231 patients received β-lactam prophylaxis. Among these, there were 115 cases of early-onset VAP (EO-VAP), 49 of late-onset VAP (LO-VAP), and 102 deaths. All studies were conducted in Europe. Causes of coma included trauma, stroke, and CO poisoning. Intravenous β-lactams (ampicillin/sulbactam, cefuroxime, and ceftriaxone) reduced EO-VAP risk by 57% (RR 0.43; 95% CI 0.30-0.61), and all-VAP by 35% (RR 0.65; 95% CI 0.53-0.80). No impact was observed on LO-VAP (RR 0.95; 95% CI 0.54-1.67), 28-day mortality (RR 0.76; 95% CI 0.53-1.09), intubation duration (SMD -0.13; 95% CI -0.46-0.21), or ICU length of stay (SMD -0.22; 95% CI -0.55-0.12). Heterogeneity and the risk of bias were low, with high overall evidence certainty.
Conclusions: In adult patients in coma due to ABI, intravenous β-lactam antibiotics reduce EO-VAP and all-VAP risk.
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