Evaluation of inhaled antimicrobials as adjunctive therapy in the treatment of ventilator-associated pneumonia

Background
Nebulized antibiotics show notable efficacy owing to their significant local concentrations and provide safety with low blood levels. In addition to these measurements, duration of hospitalization, ICU stay, days used to administer antibiotics, days on mechanical ventilation, days without mechanical ventilation, days until clinical cure, and mortality rate were used to evaluate effectiveness. Nephrotoxicity was significantly lowered in the nebulized group due to the significant preservation of kidney functionality.


Objective
To assess the role of inhaled antimicrobials as an adjunctive treatment in the therapy of ventilator-associated pneumonia (VAP).


Patients and methods
In this case–control prospective study, 70 patients with VAP were admitted to respiratory ICU at Abbassia Chest Disease Hospital between September 2018 and September 2019.


Results
Univariate logistic regression analysis revealed that significant predictors correlated with resolution of VAP were age less than or equal to 53 years [P=0.031; odds ratio (OR): 3.474, confidence interval (CI): 1.121–10.763] and duration of mechanical ventilation less than or equal to 11 days (P=0.022; OR: 3.778, CI: 1.215–11.746), while on multivariate logistic regression analysis, duration of mechanical ventilation less than or equal to 11 days was the most significant predictor for the resolution of VAP (P=0.040; OR: 3.396, CI: 1.058–10.905).


Conclusion
Based on our findings, treatment with inhaled antibiotics was associated with significantly higher incidence of VAP resolution as well as significantly shorter duration of mechanical ventilation. However, no significant variance was reported among inhaled antibiotics and control groups in our study regarding the incidence of complications or mortality. Failure of resolution of VAP was correlated with significantly older age, higher incidence of Ischemic heart disease, longer period of mechanical ventilation as well as significantly lower reduction of Clinical Pulmonary Infection Score. Duration of mechanical ventilation 11 days or less was the most significant predictor for the resolution of VAP.