A Systematic Review and Meta-analysis to Assess the Safety and Efficacy of Nebulised Colistin as an Adjunct for the Treatment of Ventilator Associated Pneumonia (VAP)
Notice bibliographique
Résumé
Abstract Rationale: Ventilator-associated pneumonia, particularly when caused by multidrug-resistant pathogens, can result in mortality rates as high as 76%. Nebulised colistin has been studied as a potential adjunct therapy for patients with ventilator-associated pneumonia (VAP); however, there is still a lack of evidence either supporting or opposing the use of nebulised colistin. This systematic review and meta-analysis were conducted to evaluate the safety and efficacy of nebulised colistin as an adjunct to intravenous (IV) antibiotics, compared to IV antibiotics alone, in patients with VAP. Methods: We systematically searched PubMed, Web of Science, Google Scholar, Embase, and the Cochrane Library to retrieve studies published at any time until April 18, 2024. The studies included in this analysis were selected based on the PICOS principle, which stands for Population, Intervention, Comparator, Outcome, and Study design. Only dual-arm studies on adults, where the intervention group received nebulised colistin with at least one IV antibiotic and the comparator group received IV antibiotics alone, were included in the analysis. The primary outcome was clinical response. Secondary outcomes included microbiological eradication and adverse events. To assess the quality of case-control/cohort studies, the Newcastle-Ottawa Quality Assessment Scale was utilised, while the Cochrane risk-of-bias tool was used for RCTs. Results: A total of 11 studies (four randomised controlled trials [RCTs] and seven observational studies) were included. The meta-analysis revealed that nebulised colistin significantly improved the clinical response in VAP patients [Odds Ratio (OR): 1.37; 95% Confidence Interval (CI): 1.05-1.80; p = 0.02]. Subgroup analysis showed significant improvement in observational studies, but no statistical significance in RCTs (OR: 1.13; 95% CI: 0.75-1.69; p = 0.16). Nebulised colistin also enhanced microbiological eradication (OR: 2.13; 95% CI: 1.27-3.56; p = 0.004). Although the incidence of bronchospasm was higher (OR: 5.19; 95% CI: 1.05-25.52; p = 0.04), the overall risk of adverse events was not significantly increased compared to IV antibiotics alone (OR: 0.89; 95% CI: 0.66-1.2; p = 0.46). Most of the included publications had a low risk of bias, and the risk of publication bias was also not serious. The quality of evidence was graded moderate for RCTs and very low for observational studies, due to inadequate sample sizes and heterogeneity. Conclusion: In conclusion, adding nebulised colistin to intravenous antibiotics can improve treatment outcomes in VAP. Despite the potential for bronchospasm, the overall risk of adverse effects is not excessively high. Further research is necessary to determine suitable nebulised doses and appropriate ventilator settings.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,017 | 0,042 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,002 |
| Méta-épidémiologie (sens large) | 0,026 | 0,042 |
| Bibliométrie | 0,011 | 0,010 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,003 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».