Efficacy and safety of nebulized antibiotics in treating ventilator-associated pneumonia

Abstract

Background Development of ventilator-associated pneumonia (VAP) is associated with high morbidity and mortality rates. VAP mortality ranges between 5.8 and 27%. When administrating intravenous antibiotics they are mainly detected in respiratory segments of the lungs, but not in the sputum and does not reach an effective bactericidal concentrations in the lung tissues. The objective of this study was to evaluate the efficacy and safety of nebulized antibiotics in treating VAP. Patients and methods This study included 60 patients who were admitted to the Critical Care Department at Benha University Hospital and diagnosed with VAP. Patients were divided into two groups: group A included 30 patients who have received only systemic antibiotics and group B included 30 patients who have received systemic and nebulized antibiotics. Results A significant difference was observed between both groups as regards organism clearance (50 vs 70%, P=0.03), resistance was 20 vs 6.7% and superinfection was 16.7 vs 0.0%, in groups A vs B, respectively. Clinical pulmonary infection score was less than 6 in 53.3% of group A vs 73.3% of group B but without significant statistical difference, P value was 0.108. There was no serious adverse effects on renal or respiratory system in both groups. Regarding ICU mortality, there was no significant difference, P value was 0.091. Conclusion Nebulized amikacin and ceftazidime are safe and effective in the treatment of VAP especially at the level of eradicating infection with multidrug resistant organisms and this benefit is obvious when used as an adjunct to systemic antibiotics and with proper nebulizing techniques.