TY - JOUR
TI - Use of nebulized antimicrobials for the treatment of respiratory
infections in invasively mechanically ventilated adults: a position
paper from the European Society of Clinical Microbiology and Infectious
Diseases
AU - Rello, J.
AU - Sole-Lleonart, C.
AU - Rouby, J. -J.
AU - Chastre, J. and
AU - Blot, S.
AU - Poulakou, G.
AU - Luyt, C. -E.
AU - Riera, J.
AU - Palmer, L.
AU - B.
AU - Pereira, J. M.
AU - Felton, T.
AU - Dhanani, J.
AU - Bassetti, M.
AU - and Welte, T.
AU - Roberts, J. A.
JO - Clinical Microbiology and Infection
PY - 2017
VL - 23
TODO - 9
SP - 629-639
PB - Elsevier Sci Ltd, Exeter, United Kingdom
SN - 1198-743X
TODO - 10.1016/j.cmi.2017.04.011
TODO - Aminoglycosides; Antibiotic aerosolization; Colistin;
Multidrug-resistant organisms; Nosocomial pneumonia; Regulatory issues;
Ventilator-associated pneumonia; Ventilator-associated tracheobronchitis
TODO - With an established role in cystic fibrosis and bronchiectasis,
nebulized antibiotics are increasingly being used to treat respiratory
infections in critically ill invasively mechanically ventilated adult
patients. Although there is limited evidence describing their efficacy
and safety, in an era when there is a need for new strategies to enhance
antibiotic effectiveness because of a shortage of new agents and
increases in antibiotic resistance, the potential of nebulization of
antibiotics to optimize therapy is considered of high interest,
particularly in patients infected with multidrug-resistant pathogens.
This Position Paper of the European Society of Clinical Microbiology and
Infectious Diseases provides recommendations based on the Grading of
Recommendations Assessment, Development and Evaluation (GRADE)
methodology regarding the use of nebulized antibiotics in invasively
mechanically ventilated adults, based on a systematic review and
meta-analysis of the existing literature (last search July 2016).
Overall, the panel recommends avoiding the use of nebulized antibiotics
in clinical practice, due to a weak level of evidence of their efficacy
and the high potential for underestimated risks of adverse events
(particularly, respiratory complications). Higher-quality evidence is
urgently needed to inform clinical practice. Priorities of future
research are detailed in the second part of the Position Paper as
guidance for researchers in this field. In particular, the panel
identified an urgent need for randomized clinical trials of nebulized
antibiotic therapy as part of a substitution approach to treatment of
pneumonia due to multidrugresistant pathogens. (C) 2017 European Society
of Clinical Microbiology and Infectious Diseases. Published by Elsevier
Ltd. All rights reserved.
ER -