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Centre for Evidence-
Based Medicine

Mechanical ventilation: Antibiotic prophylaxis decreases respiratory tract infection and mortality in critically ill patients

Clinical Bottom Line

  1. Antibiotic prophylaxis decreases the incidence of respiratory tract infection and mortality in critically ill patients requiring mechanical ventilation.
  2. Prophylaxis with topical antibiotics alone decreases the incidence of respiratory tract infection in critically ill patients requiring mechanical ventilation, but does not decrease mortality.

Citation

Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials. BMJ 1998;316:1275-85.

Clinical Question

In critically ill patients requiring mechanical ventilation, does prophylactic antibiotics reduce the risk of respiratory tract infection?

Search Terms

"Critical care", "Antibiotics", "Respiratory tract infections" in Medline

The Study

Systematic review of RCTs that studied topical plus systemic antibiotics versus no treatment and topical preparations with or without systemic antibiotics versus a systemic agent or placebo in unselected critically ill adult patients with outcomes of respiratory tract infections or death.

The Evidence

16 trials (3361 patients) of topical plus systemic antibiotics; 17 trials (2366 patients) of only topical antibiotics.
Intervention Outcome CER (weighted) EER (weighted) RRR ARR (weighted) [95% CI] NNT [95% CI]
Systemic and Topical Antibiotic Respiratory Tract Infection .36 .16 .56 .20 [.20 - .25] 5 [4 - 5]
Mortality .30 .24 .20 .06 [.01 - .07] 23 [14 - 68]
Topical Antibiotic Respiratory Tract Infection .28 .18 .36 .10 [.08 - .14] 9 [7 - 13]
Mortality .26 .26 0 0 N/A

Comments

  1. The treatment effect is consistent across type of patient (medical, surgical, or trauma and APACHE II stratification.
  2. No significant difference in pooled data from individual patients v. aggregate data.
  3. Review does not allow a unique antibiotic regimen to be chosen.

Created by Berenholtz S, Pronovost P

Appraised By

Pronovost P, 1999

Expiry Date

2000