Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review
Background: Ventilator-associated lower respiratory tract infectious complications in critically ill patients cover a wide spectrum of one disease process (respiratory infection), initiating from tracheal tube and/or tracheobronchial colonization, to ventilator associated tracheobronchitis (VAT) and...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/12/5/801 |
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| author | Pavlos Myrianthefs George E. Zakynthinos Vasiliki Tsolaki Demosthenes Makris |
| author_facet | Pavlos Myrianthefs George E. Zakynthinos Vasiliki Tsolaki Demosthenes Makris |
| author_sort | Pavlos Myrianthefs |
| collection | DOAJ |
| description | Background: Ventilator-associated lower respiratory tract infectious complications in critically ill patients cover a wide spectrum of one disease process (respiratory infection), initiating from tracheal tube and/or tracheobronchial colonization, to ventilator associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP). VAP occurence has been associated with increased intensive care unit (ICU) morbidity (ventilator days, as well as length of ICU and hospital stay) and ICU mortality. Therefore, treatments that aim at VAP/VAT incidence reduction are a high priority. Aim: The aim of the present review is to discuss the current literature concerning two major aspects: (a) can aerosolized antibiotics (AA) administered in a pre-emptive way prevent the occurrence of ventilator-associated infections? and (b) can VAT treatment with aerosolized avert the potential evolution to VAP? Results: There were identified eight studies that provided data on the use of aerosolized antibiotics for the prevention of VAT/VAP. Most of them report favorable data on reducing the colonisation rate and the progression to VAP/VAT. Another four studies dealt with the treatment of VAT/VAP. The results support the decrease in the incidence to VAP transition and/or the improvement in signs and symptoms of VAP. Moreover, there are concise reports on higher cure rates and microbiological eradication in patients treated with aerosolized antibiotics. Yet, differences in the delivery modality adopted and resistance emergence issues preclude the generalisability of the results. Conclusion: Aerosolized antibiotic therapy can be used to manage ventilator-associated infections, especially those with difficult to treat resistance. The limited clinical data raise the need for large randomized controlled trials to confirm the benefits of AA and to evaluate the impact on antibiotic selection pressure. |
| first_indexed | 2024-03-11T04:00:56Z |
| format | Article |
| id | doaj.art-c17c7fc4c2ab40699c0d99116056f267 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-11T04:00:56Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-c17c7fc4c2ab40699c0d99116056f2672023-11-18T00:11:25ZengMDPI AGAntibiotics2079-63822023-04-0112580110.3390/antibiotics12050801Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive ReviewPavlos Myrianthefs0George E. Zakynthinos1Vasiliki Tsolaki2Demosthenes Makris3“Agioi Anargyroi” General Hospital, School of Health Sciences, Department of Nursing, National and Kapodistrian University of Athens, 14564 Athens, GreeceThird Cardiology Clinic, University of Athens, Sotiria Hospital, 11526 Athens, GreeceDepartment of Intensive Care Medicine, University Hospital of Larissa, 41110 Larissa, GreeceDepartment of Intensive Care Medicine, University Hospital of Larissa, 41110 Larissa, GreeceBackground: Ventilator-associated lower respiratory tract infectious complications in critically ill patients cover a wide spectrum of one disease process (respiratory infection), initiating from tracheal tube and/or tracheobronchial colonization, to ventilator associated tracheobronchitis (VAT) and ventilator-associated pneumonia (VAP). VAP occurence has been associated with increased intensive care unit (ICU) morbidity (ventilator days, as well as length of ICU and hospital stay) and ICU mortality. Therefore, treatments that aim at VAP/VAT incidence reduction are a high priority. Aim: The aim of the present review is to discuss the current literature concerning two major aspects: (a) can aerosolized antibiotics (AA) administered in a pre-emptive way prevent the occurrence of ventilator-associated infections? and (b) can VAT treatment with aerosolized avert the potential evolution to VAP? Results: There were identified eight studies that provided data on the use of aerosolized antibiotics for the prevention of VAT/VAP. Most of them report favorable data on reducing the colonisation rate and the progression to VAP/VAT. Another four studies dealt with the treatment of VAT/VAP. The results support the decrease in the incidence to VAP transition and/or the improvement in signs and symptoms of VAP. Moreover, there are concise reports on higher cure rates and microbiological eradication in patients treated with aerosolized antibiotics. Yet, differences in the delivery modality adopted and resistance emergence issues preclude the generalisability of the results. Conclusion: Aerosolized antibiotic therapy can be used to manage ventilator-associated infections, especially those with difficult to treat resistance. The limited clinical data raise the need for large randomized controlled trials to confirm the benefits of AA and to evaluate the impact on antibiotic selection pressure.https://www.mdpi.com/2079-6382/12/5/801aerosolized antibioticsintensive care unitlower respiratory tract infectionsnebulized antibioticstracheal tube colonizationtreatment |
| spellingShingle | Pavlos Myrianthefs George E. Zakynthinos Vasiliki Tsolaki Demosthenes Makris Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review Antibiotics aerosolized antibiotics intensive care unit lower respiratory tract infections nebulized antibiotics tracheal tube colonization treatment |
| title | Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review |
| title_full | Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review |
| title_fullStr | Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review |
| title_full_unstemmed | Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review |
| title_short | Aerosolized Antibiotics to Manage Ventilator-Associated Infections: A Comprehensive Review |
| title_sort | aerosolized antibiotics to manage ventilator associated infections a comprehensive review |
| topic | aerosolized antibiotics intensive care unit lower respiratory tract infections nebulized antibiotics tracheal tube colonization treatment |
| url | https://www.mdpi.com/2079-6382/12/5/801 |
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