Effect of aerosolized antibiotics on patients with ventilator associated pneumonia: a meta-analysis

Objective To evaluate the effect of aerosolized antibioticson patients with ventilator associated pneumonia by meta-analysis. Methods Data of this meta-analysis was retrieved from the PubMed, Cochrane library, Wanfang, Weipu and CNKI databases from January 1980 to June 2017.Randomized controlled trials (RCT) regarding comparison of the effect of aerosolized antibioticson patients with ventilator associated pneumonia were enrolled.The enrolled data were divided into different subgroups in terms of the kinds of aerosolized antibiotics.Meta-analysis was performed to compare the effect of different subgroups by RevMan 5.3. Results 11 studies with a total of 827 patients were included.Aerosolized antibiotics improved the resolution (RR: 1.17, 95%CI: 1.02-1.33, P=0.02), promoted weaning from mechanical ventilation (RR: 1.49, 95%CI: 1.16-1.90, P=0.002), which did not promoted emergence of new drug-resistant bacteria (RR: 0.15, 95%CI: 0.04-0.49, P=0.002), improved bronchospasm (RR: 2.40, 95%CI: 1.24-4.68, P=0.010), decreased nephrotoxicity (RR: 0.57, 95%CI: 0.40-1.82, P=0.003); While did not reduce the risk of mortality.Subgroup analysis showed that just aerosolized aminoglycoside antibiotics did not improve the incidence of bronchospasm. Conclusions Aerosolized antibiotics can improve resolution, weaning from mechanical ventilation, decrease emergence of new drug-resistance, while can not reduce the risk of mortality, Aerosolized antibiotics can decrease nephrotoxicity, improve the incidence of bronchospasm, but just aerosolized aminoglycoside antibiotics can not improve bronchospasm or decrease nephrotoxicity. Key words: Ventilator-associated pneumonia; Aerosolized antibiotics; Meta-analysis