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Antibiotics for preventing respiratory tract infections in adults receiving intensive care

  1. A Liberati*,
  2. R D'Amico,
  3. S Pifferi,
  4. C Leonetti,
  5. V Torri,
  6. L Brazzi,
  7. A Tinazzi

Editorial Group: Cochrane Acute Respiratory Infections Group

Published Online: 7 FEB 2000

DOI: 10.1002/14651858.CD000022


How to Cite

Liberati, A., D'Amico, R., Pifferi, S., Leonetti, C., Torri, V., Brazzi, L., Tinazzi, A. 2000. Antibiotics for preventing respiratory tract infections in adults receiving intensive care

Author Information

  1. Laboratory of Clinical Epidemiology, "Mario Negri Institute", Italian Cochrane Centre, Milano, ITALY

*A Liberati, Italian Cochrane Centre, Laboratory of Clinical Epidemiology, "Mario Negri Institute", Via Eritrea 62, Milano, 20157, ITALY. Cochrane@irfmn.mnegri.it.

Publication History

  1. Publication Status: Commented
  2. Published Online: 7 FEB 2000

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This is not the most recent version of the article. View current version (07 OCT 2009)

 

Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Pneumonia is an important cause of mortality in intensive care units. The incidence of pneumonia in such patients ranges between 7% and 40%, and the crude mortality from ventilator associated pneumonia may exceed 50%. Although not all deaths in patients with this form of pneumonia are directly attributable to infections, it has been shown to contribute to mortality in intensive care units independently of other factors that are also strongly associated with such deaths.

Objectives

The objective of this review was to assess the effects of antibiotics for preventing respiratory tract infections and overall mortality in adults receiving intensive care.

Search strategy

We searched Medline, the Cochrane Acute Respiratory Infections Group trials register, proceedings of scientific meetings and reference lists of articles from January 1984 to December 1999. We also contacted investigators in the field.

Selection criteria

Randomised trials of antibiotic prophylaxis for respiratory tract infections and deaths among adult intensive care unit patients.

Data collection and analysis

Investigators were contacted for additional information. At least two reviewers independently extracted data and assessed trial quality.

Main results

Overall 33 trials involving 5727 people were included. There was variation in the antibiotics used, patient characteristics and risk of respiratory tract infections and mortality in the control groups. In 16 trials (involving 3361 patients) that tested a combination of topical and systemic antibiotic, the average rates of respiratory tract infections and deaths in the control group were 36% and 30% respectively. There was a significant reduction of both respiratory tract infections (odds ratio 0.35, 95% confidence interval 0.29 to 0.41) and total mortality (odds ratio 0.80, 95% confidence interval 0.69 to 0.93) in the treated group. On average 5 patients needed to be treated to prevent one infection and 23 patients to prevent one death. In 17 trials (involving 2366 patients) that tested topical antimicrobials the rates of respiratory tract infections and deaths in the control groups were 28% and 26% respectively. There was a significant reduction of respiratory tract infections (odds ratio 0.56, 95% confidence interval 0.46 to 0.68) but not in total mortality (odds ratio 1.01, 95% confidence interval 0.84 to 1.22) in the treated group.

Reviewer's conclusions

A combination of topical and systemic prophylactic antibiotics can reduce respiratory tract infections and overall mortality in adult patients receiving intensive care. The design of the trials included in this systematic review does not allow to assess whether or not the treatment leads to antimicrobial resistance. Trials with different design are warranted to reliably address this question.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Synopsis

Antibiotics can help reduce respiratory infections in people receiving intensive care in hospital

People who need ventilation (mechanical breathing support) in intensive care can develop respiratory tract infections or pneumonia (a lung infection). Some people will die because of these infections. The review of trials found that a combination of antibiotics that are topical (where a drug is applied directly to the part being treated) and systemic (affecting the whole body) reduces infections and therefore death from these infections. The use of topical antibiotics alone will reduce the person's infection but not influence their survival.