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Available online 26 March 2025
β-lactam antibiotics to prevent ventilator-associated pneumonia (VAP) in coma patients: A systematic review and meta-analysis of randomized controlled trials
Antibióticos betalactámicos para prevenir la neumonía asociada al ventilador (NAV) en pacientes en coma: una revisión sistemática y un metaanálisis de ensayos controlados aleatorizados
Edinson Dante Meregildo-Rodrigueza,b,
Corresponding author
edmeregildo@ucvvirtual.edu.pe

Corresponding author.
, Mariano Ortiz-Pizarroc, Martha Genara Asmat-Rubiod, Carlos Geraldo Fernandez-Narváeze, Gustavo Adolfo Vásquez-Tiradof
a Escuela de Posgrado, Universidad Señor de Sipán, Chiclayo, Peru
b Servicio de Medicina Interna, Hospital Regional Lambayeque, Chiclayo, Peru
c Escuela de Odontología, Universidad Católica Santo Toribio de Mogrovejo, Chiclayo, Peru
d Escuela de Farmacia y Bioquímica, Universidad Nacional de Trujillo, Trujillo, Peru
e Escuela de Medicina, Universidad Católica Santo Toribio de Mogrovejo, Chiclayo, Peru
f Escuela de Medicina, Universidad Privada Antenor Orrego, Trujillo, Peru
Received 06 November 2024. Accepted 04 March 2025
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Abstract
Objective

To evaluate the effect of parenteral β-lactam antibiotics on outcomes related to ventilator-associated pneumonia (VAP) in adult patients in coma due to acute brain injury (ABI).

Design

Systematic review and meta-analysis.

Setting

Randomized controlled trials (RCTs) published up toSeptember 30, 2024.

Patients or participants

Adult patients in coma due to ABI.

Interventions

Parenteral β-lactam antibiotics.

Main variables of interest

Incidence and outcomes related to VAP.

Results

Three RCTs involving 483 patients met inclusion criteria; 231 patients received β-lactam prophylaxis. Among these, there were 115 cases of early-onset VAP (EO-VAP), 49 of late-onset VAP (LO-VAP), and 102 deaths. All studies were conducted in Europe. Causes of coma included trauma, stroke, and CO poisoning. Intravenous β-lactams (ampicillin/sulbactam, cefuroxime, and ceftriaxone) reduced EO-VAP risk by 57% (RR 0.43; 95% CI 0.30–0.61), and all-VAP by 35% (RR 0.65; 95% CI 0.53–0.80).

No impact was observed on LO-VAP (RR 0.95; 95% CI 0.54–1.67), 28-day mortality (RR 0.76; 95% CI 0.53–1.09), intubation duration (SMD -0.13; 95% CI −0.46–0.21), or ICU length of stay (SMD −0.22; 95% CI −0.55–0.12). Heterogeneity and the risk of bias were low, with high overall evidence certainty.

Conclusions

In adult patients in coma due to ABI, intravenous β-lactam antibiotics reduce EO-VAP and all-VAP risk.

Keywords:
β-lactams
Prevention
Ventilator-associated pneumonia
Coma
Systematic review
Meta-analysis
Resumen
Objetivo

Evaluar el efecto de los antibióticos β-lactámicos parenterales en los resultados relacionados con la neumonía asociada a ventilación mecánica (NAV) en pacientes adultos en coma debido a lesión cerebral aguda (LCA).

Diseño

Revisión sistemática y metaanálisis.

Ámbito

Ensayos controlados aleatorizados (ECA) publicados hasta el 30 de septiembre de 2024.

Pacientes o participantes

Pacientes adultos en coma debido a LCA.

Intervenciones

Antibióticos β-lactámicos parenterales.

Variables de interésprincipales

Incidencia y desenlaces relacionados con la NAV.

Resultados

Incluimos tres ECA, 483 pacientes, de los cuales, 231 recibieron profilaxis con β-lactámicos. Hubo 115 casos de NAV de inicio temprano (NAV-IT), 49 de NAV de inicio tardío (NAV-ITD) y 102 muertes. Todos los estudios se realizaron en Europa. Las causas de coma incluyeron traumatismo, accidente cerebrovascular e intoxicación por CO. Los β-lactámicos intravenosos (ampicilina/sulbactam, cefuroxima y ceftriaxona) redujeron el riesgo de NAV-IT en un 57% (RR 0,43; IC 95% 0,30–0,61), y de NAV total en un 35% (RR 0,65; IC 95% 0,53–0,80).

No se observó impacto en NAV-ITD (RR 0,95; IC 95% 0,54–1,67), mortalidad a 28 días (RR 0,76; IC 95% 0,53–1,09), duración de la intubación (DMS -0,13; IC 95% -0,46–0,21) o estancia en UCI (DMS -0,22; IC 95% -0,55–0,12). La heterogeneidad y el riesgo de sesgo fueron bajos, con una alta certeza en la evidencia.

Conclusiones

En pacientes adultos en coma debido a LCA, los antibióticos β-lactámicos intravenosos reducen el riesgo de NAV-IT y de NAV total.

Palabras clave:
β-lactámicos
Prevención
Neumonía asociada a ventilación mecánica
Coma
Revisión sistemática
Metaanálisis

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