VAP短期VS长期抗生素方案:meta分析

拙凌

Short- vs Long-Duration Antibiotic Regimens for Ventilator-Associated Pneumonia:A Systematic Review and Meta-analysis

George Dimopoulos, MD, PhD; Garyphallia Poulakou, MD, PhD; Ioannis A. Pneumatikos, MD, PhD; Apostolos Armaganidis, MD, PhD; Marin H. Kollef, MD, FCCP; Dimitrios K. Matthaiou, MD

Chest. 2013;144(6):1759-1767. doi:10.1378/chest.13-0076

Background:  We performed a systematic review and meta-analysis of short- vs long-duration antibiotic regimens for ventilator-associated pneumonia (VAP).

Methods:  We searched PubMed and Cochrane Central Registry of Controlled Trials. Four randomized controlled trials (RCTs) comparing short (7-8 days) with long (10-15 days) regimens were identified. Primary outcomes included mortality, antibiotic-free days, and clinical and microbiologic relapses. Secondary outcomes included mechanical ventilation-free days, duration of mechanical ventilation, and length of ICU stay.

Results:  All RCTs included mortality data, whereas data on relapse and antibiotic-free days were provided in three and two out of four RCTs, respectively. No difference in mortality was found between the compared arms (fixed effect model [FEM]: OR = 1.20; 95% CI, 0.84-1.72; P = .32). There was an increase in antibiotic-free days in favor of the short-course treatment with a pooled weighted mean difference of 3.40 days (random effects model: 95% CI, 1.43-5.37; P < .001). There was no difference in relapses between the compared arms, although a strong trend to lower relapses in the long-course treatment was observed (FEM: OR = 1.67; 95% CI, 0.99-2.83; P = .06). No difference was found between the two arms regarding the remaining outcomes. Sensitivity analyses yielded similar results.

Conclusions:  Short-course treatment of VAP was associated with more antibiotic-free days. No difference was found regarding mortality and relapses; however, a strong trend for fewer relapses was observed in favor of the long-course treatment, being mostly driven by one study in which the observed relapses were probably more microbiologic than clinical. Additional research is required to elucidate the issue.

吴晓梅

才疏学浅看不懂，最好哪位老师翻译一下。

佳蕙淼淼

纸上得来终觉浅，绝知此事要躬行.
呵呵。新年吉祥！优化抗生素的应用，减少抗生素的滥用是要有循证医学依据的。
立意好的好文章！
谢谢楼主的分享！

佳蕙淼淼

做需要我们做的!
做我们能做的！
做有可能很快有效果的事情！
文章立意可行性好，值得借鉴！

jcyyhlb

楼上老师辛苦了，能翻译成中文就好了谢谢老师。