Aerosolized Combined With Intravenous Antibiotics Versus Intravenous Antibiotics For Ventilator-associated Pneumonia: A Meta-analysis

Objective To study the effect of aerosolized combined withintravenous antibiotics comparing with intravenous antibiotics forsuccessful treatment， mortality， preventing complication， improvingweaning and the prognosis in ventilator-associated pneumonia patients.Method The data were collected from January1990to March2013，including pubmed， OVID， the Cochrane library， Elsevier et. AndCBMdisc，CNKI，and manually screened when necessary. The studies werelimited Randomized controlled trials(RCTs) that published or unpublishedin English and Chinese literatures comparing aerosolized combined withintravenous antibiotics and intravenous antibiotics in ventilator-associatedpneumonia patients.Results Finally，five RCTs with231subjects were included inthis meta-analysis, in which116subjects were treated by aerosolizedcombined with intravenous antibiotics and others were treated by intravenous antibiotics. These RCTs are all high quality studies with Jadadscores of above four points. The meta-analysis of RCTs showed thatcomparing with the intravenous antibiotics, use of combination therapy canimprove the clinical successful treatment rate of VAPpatients(RR=1.33,95%CI（1.02，1.74），P=0.03＜0.05)，whereas themortality rate showed no significant difference(RR=1.02，95%CI(0.67,1.53)，P=0.94）. According this study we can find thecombination therapy will not increase the risk of resistance organism(RR=0.34，95%CI(0.02,5.57)，P=0.45＞0.05).The results also showed thataerosolized combined with intravenous could not improve weaning frommechanical ventilation of VAP patients(RR=1.74,95%CI（0.99，3.07），P=0.05).And also, there were no difference in the serum creatinineconcentration(MD=-0.30,95%CI（-0.91,0.31），P=0.34),and the risk ofhappening the bronchospasm(RR=2.27,95%CI（0.46,11.08），P=0.31),itmay suggest that patients who had ventilator-associated pneumonia hadwell tolerance with the therapy of aerosolized combined with intravenousantibiotics.Conclusion patients with VAP received higher rate of clinicalsuccessful treatment rate by using the combination therapy, whereas couldnot reduce the rate of mortality or weaning from mechanical ventilation.Comparing with intravenous antibiotics, aerosolized combined with intravenous antibiotics would not increase the concentration of serumcreatinine or the risk of bronchospasm.