Effect of Antibiotic Treatment on Ventilator-Associated Tracheobronchitis: A Meta-analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SunLi , ZhangChen , ZhangSiqin , LuoJian ,  LiangZongan

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China;

Corresponding?author：

LiangZongan, Email: liangza@scu.edu.cn

Keywords：

Ventilator-associated tracheobronchitis; Ventilator-associated pneumonia; Antibiotics; Meta-analysis

DOI：

10.7507/1671-6205.2016080

Video：

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Objective To evaluate systematically the effect of antibiotic treatment on ventilator-associated tracheobronchitis (VAT). Methods Pubmed,Web of Science,OVID SP (ACP Journal Club,Cochrane Central Register of Contralled Trials,Embase,Medline),as well as China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data were searched for literatures about antibiotic treatment on VAT.The search deadline was March 2016.Meta-analysis was conducted with RevMan 5.3 software. Results A total of 6 studies with 769 patients were included.Among 769 patients,432 patients were treated by antibiotics,and 337 patients in control group were treated without antibiotics.Meta-analysis showed antibiotics treatment significantly reduced incidence of ventilator-associated pneumonia compared with control group [OR=0.27,95%CI (0.17,0.43),P<0.05],and shortened length of ICU stay [MD -1.51,95%CI(-2.04,-0.98),P<0.00001] .There were no significant difference in duration of mechanical ventilation [MD -2.52,95%CI (-6.85,1.81),P=0.25],mortality [OR=0.41,95%CI(0.15,1.14),P=0.09],or drug-resistant bacteria production [OR=0.62,95%CI(0.17,2.19),P>0.05]. Conclusions Antibiotic treatment can reduce incidence of ventilator-associated pneumonia in patients with VAT.Further more high quality randomized controlled trials are needed to assess the effect of antibiotic treatment on VAT.

Citation： SunLi, ZhangChen, ZhangSiqin, LuoJian, LiangZongan. Effect of Antibiotic Treatment on Ventilator-Associated Tracheobronchitis: A Meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(4): 337-343. doi: 10.7507/1671-6205.2016080 Copy

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2.	Agrafiotis M,Siempos II,Falagas ME,et al.Frequency,prevention,outcome and treatment of ventilator-associated tracheobronchitis:systematic review and meta-analysis.Respir Med,2010,104:325-36.
3.	Nseir S,Ader F,Marquette C,et al.Nosocomial tracheobronchitis.Curr Opin Infect Dis,2009,22:148-153.
4.	Nseir S,Favory R,Jozefowicz E,et al.Antimicrobial treatment for ventilator-associated tracheobronchitis:a randomized,controlled,multicenter study.Crit Care,2008,12:R62.
5.	Palmer LB,Smaldone GC,Chen JJ,et al.Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit.Crit Care Med,2008,36:2008-2013.
6.	Nseir S,Martin-Loeches I,Makris D,et al.Impact of appropriate antimicrobial treatment on transition from ventilator-associated tracheobronchitis to ventilator-associated pneumonia.Crit Care,2014,18:R129.
7.	劉慶華, 何禮賢,諸杜明,等.醫院內氣管支氣管炎危險因素和病原學分析.中華結核和呼吸雜志,2005,28:134-135.
8.	Martin-Loeches I,Povoa P,Rodriguez A,et al.Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM):a multicentre, prospective,observational study.Lancet Respir Med,2015,3:859-868.
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11.	李華茵, 何禮賢,胡必杰,等.重癥監護病房機械通氣相關性肺炎危險因素的前瞻性隊列研究.中華內科雜志,2004,43:325-328.
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13.	Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare-associated pneumonia.Am J Respir Crit Care Med,2005,171:388-416.
14.	Obrador GT,Villa AR,Olvera N,et al.Longitudinal analysis of participants in the KEEP Mexico's chronic kidney disease screening program.Arch Med Res,2013,44:650-654.
15.	Stang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.Eur J Epidemiol,2010,25:603-605.
16.	Nseir S,Di Pompeo C,Soubrier S,et al.Outcomes of ventilated COPD patients with nosocomial tracheobronchitis:a case-control study.Infection,2004,32:210-216.
17.	張靖軒, 周華榮,劉宗師,等.短期使用抗生素或霧化吸入痰熱清注射液對呼吸機相關性支氣管炎患者影響的研究.中國中醫急癥,2013,22:1499-1500.
18.	張靖軒, 周華榮,劉宗師,等.霧化布地奈德或使用抗生素對呼吸機相關性支氣管炎的影響.嶺南急診醫學雜志,2013,18:245-246.
19.	Craven DE,Lei Y,Ruthazer R,et al.Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia.Am J Med,2013,126:542-549.
20.	Dallas J,Skrupky L,Abebe N,et al.Ventilator-associated tracheobronchitis in a mixed surgical and medical ICU population.Chest,2011,139:513-518.
21.	Nseir S,Di Pompeo C,Soubrier S,et al.Effect of ventilator-associated tracheobronchitis on outcome in patients without chronic respiratory failure:a case-control study.Crit Care,2005,9:R238-R245.
22.	Unroe M,Kahn JM,Carson SS,et al.One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation:a cohort study.Ann Intern Med,2010,153:167-175.
23.	Pandharipande PP,Girard TD,Ely EW.Long-term cognitive impairment after critical illness.N Engl J Med,2014,370:185-186.
24.	Craven DE,Hudcova J,Rashid J.Antibiotic therapy for ventilator-associated tracheobronchitis:a standard of care to reduce pneumonia,morbidity and costs? Curr Opin Pulm Med,2015.21:250-259.
25.	張靜, 沈寧,周慶濤,等.呼吸機相關性氣管支氣管炎對慢性阻塞性肺疾病預后的影響.中華醫院感染學雜志,2015,25:127-129.
26.	Craven DE,Hudcova J,Craven KA,et al.Antibiotic treatment of ventilator-associated tracheobronchitis:to treat or not to treat? Curr Opin Crit Care,2014,20:532-541.
27.	崔雅如, 甘樂文,張睢揚.霧化吸入阿米卡星治療銅綠假單胞菌性呼吸機相關性氣管支氣管炎.中國醫學工程,2012,20:156-157.

1. Nseir S,Di Pompeo C,Pronnier P,et al.Nosocomial tracheobronchitis in mechanically ventilated patients:incidence,aetiology and outcome.Eur Respir J,2002,20:1483-1489.
2. Agrafiotis M,Siempos II,Falagas ME,et al.Frequency,prevention,outcome and treatment of ventilator-associated tracheobronchitis:systematic review and meta-analysis.Respir Med,2010,104:325-36.
3. Nseir S,Ader F,Marquette C,et al.Nosocomial tracheobronchitis.Curr Opin Infect Dis,2009,22:148-153.
4. Nseir S,Favory R,Jozefowicz E,et al.Antimicrobial treatment for ventilator-associated tracheobronchitis:a randomized,controlled,multicenter study.Crit Care,2008,12:R62.
5. Palmer LB,Smaldone GC,Chen JJ,et al.Aerosolized antibiotics and ventilator-associated tracheobronchitis in the intensive care unit.Crit Care Med,2008,36:2008-2013.
6. Nseir S,Martin-Loeches I,Makris D,et al.Impact of appropriate antimicrobial treatment on transition from ventilator-associated tracheobronchitis to ventilator-associated pneumonia.Crit Care,2014,18:R129.
7. 劉慶華, 何禮賢,諸杜明,等.醫院內氣管支氣管炎危險因素和病原學分析.中華結核和呼吸雜志,2005,28:134-135.
8. Martin-Loeches I,Povoa P,Rodriguez A,et al.Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM):a multicentre, prospective,observational study.Lancet Respir Med,2015,3:859-868.
9. Grgurich PE,Hudcova J,Lei Y,et al.Diagnosis of ventilator-associated pneumonia:controversies and working toward a gold standard.Curr Opin Infect Dis,2013,26:140-150.
10. Abu-Salah T,Dhand R.Inhaled antibiotic therapy for ventilator-associated tracheobronchitis and ventilator-associated pneumonia:an update.Adv Ther,2011,28:728-747.
11. 李華茵, 何禮賢,胡必杰,等.重癥監護病房機械通氣相關性肺炎危險因素的前瞻性隊列研究.中華內科雜志,2004,43:325-328.
12. 中華醫學會重癥醫學分會.呼吸機相關性肺炎診斷、預防和治療指南(2013).中華內科雜志,2013,52:524-543.
13. Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare-associated pneumonia.Am J Respir Crit Care Med,2005,171:388-416.
14. Obrador GT,Villa AR,Olvera N,et al.Longitudinal analysis of participants in the KEEP Mexico's chronic kidney disease screening program.Arch Med Res,2013,44:650-654.
15. Stang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.Eur J Epidemiol,2010,25:603-605.
16. Nseir S,Di Pompeo C,Soubrier S,et al.Outcomes of ventilated COPD patients with nosocomial tracheobronchitis:a case-control study.Infection,2004,32:210-216.
17. 張靖軒, 周華榮,劉宗師,等.短期使用抗生素或霧化吸入痰熱清注射液對呼吸機相關性支氣管炎患者影響的研究.中國中醫急癥,2013,22:1499-1500.
18. 張靖軒, 周華榮,劉宗師,等.霧化布地奈德或使用抗生素對呼吸機相關性支氣管炎的影響.嶺南急診醫學雜志,2013,18:245-246.
19. Craven DE,Lei Y,Ruthazer R,et al.Incidence and outcomes of ventilator-associated tracheobronchitis and pneumonia.Am J Med,2013,126:542-549.
20. Dallas J,Skrupky L,Abebe N,et al.Ventilator-associated tracheobronchitis in a mixed surgical and medical ICU population.Chest,2011,139:513-518.
21. Nseir S,Di Pompeo C,Soubrier S,et al.Effect of ventilator-associated tracheobronchitis on outcome in patients without chronic respiratory failure:a case-control study.Crit Care,2005,9:R238-R245.
22. Unroe M,Kahn JM,Carson SS,et al.One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation:a cohort study.Ann Intern Med,2010,153:167-175.
23. Pandharipande PP,Girard TD,Ely EW.Long-term cognitive impairment after critical illness.N Engl J Med,2014,370:185-186.
24. Craven DE,Hudcova J,Rashid J.Antibiotic therapy for ventilator-associated tracheobronchitis:a standard of care to reduce pneumonia,morbidity and costs? Curr Opin Pulm Med,2015.21:250-259.
25. 張靜, 沈寧,周慶濤,等.呼吸機相關性氣管支氣管炎對慢性阻塞性肺疾病預后的影響.中華醫院感染學雜志,2015,25:127-129.
26. Craven DE,Hudcova J,Craven KA,et al.Antibiotic treatment of ventilator-associated tracheobronchitis:to treat or not to treat? Curr Opin Crit Care,2014,20:532-541.
27. 崔雅如, 甘樂文,張睢揚.霧化吸入阿米卡星治療銅綠假單胞菌性呼吸機相關性氣管支氣管炎.中國醫學工程,2012,20:156-157.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of Antibiotic Treatment on Ventilator-Associated Tracheobronchitis: A Meta-analysis

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