Efficacy and safety of intravenous antibiotics combined with inhalation of amikacin versus intravenous antibiotics for treatment of ventilator-associated pneumonia: a systematic review and meta-analysis

Objective Reviewing and integrating published literature at home and abroad by meta-analysis to compare the efficacy and safety of aerosolized amikacin for treatment of ventilator-associated pneumonia (VAP). Methods Comprehensive searches were performed from the PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, VIP, China national knowledge internet and Wanfang database to acquire randomized controlled trials (RCTs) comparing intravenous antibiotics combined with inhalation of amikacin treatment with intravenous antibiotics and the data were collected from the time of establishment of databases to November 2018.The methodological quality of the included studies were assessed following the preferred reporting items for systematic reviews and meta-analysis guidelines.Statistical analysis on the data was performed by RevMan 5.3 software. Results Totally eight RCTs were included in the meta-analysis.Pooled analysis showed that compared to the intravenous antibiotics, intravenous antibiotics combined with inhalation of amikacin treatment significantly improved the clinical cure rate (OR=2.59, 95% CI: 1.87-3.59, P<0.000 01), bacterial clearance rate (OR=2.87, 95% CI: 1.93-4.27, P<0.000 01), and weaning rate (OR=1.88, 95%CI: 1.16-3.04, P=0.01). The death rate (OR=1.39, 95%CI: 0.86-2.24, P=0.18), the happening of bronchospasm (OR=2.30, 95%CI: 1.00-5.30, P=0.05) and renal dysfunction rate (OR=0.61, 95%CI: 0.34-1.11, P=0.10) were not significantly different for intravenous antibiotics combined with inhalation of amikacin versus intravenous antibiotics. Conclusions Patients with VAP received higher rate of clinical cure rate, bacterial clearance rate, and weaning rate and by using intravenous antibiotics combined with inhalation of amikacin treatment, whereas could not reduce the rate of mortality and didn′t increase the happening of bronchospasm and renal dysfunction rate. Key words: Pneumonia, ventilator-associated; Meta-analysis; Inhalation; Amikacin; Intravenous antibiotics