Reduction In Respiratory Tract Infections Research Articles

A Systematic Review Supporting the Endocrine Society Clinical Practice Guidelines on Vitamin D.

Low vitamin D status is common and is associated with various common medical conditions. To support the development of the Endocrine Society's Clinical Practice Guideline on Vitamin D for the Prevention of Disease. We searched multiple databases for studies that addressed 14 clinical questions prioritized by the guideline panel. Of the 14 questions, 10 clinical questions assessed the effect of vitamin D vs no vitamin D in the general population throughout the lifespan, during pregnancy, and in adults with prediabetes; 1 question assessed dosing; and 3 questions addressed screening with serum 25-hydroxyvitamin D (25[OH]D). The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess certainty of evidence. Electronic searches yielded 37 007 citations, from which we included 151 studies. In children and adolescents, low-certainty evidence suggested reduction in respiratory tract infections with empiric vitamin D. There was no significant effect on select outcomes in healthy adults aged 19 to 74 years with variable certainty of evidence. There was a very small reduction in mortality among adults older than 75 years with high certainty of evidence. In pregnant women, low-certainty evidence suggested possible benefit on various maternal, fetal, and neonatal outcomes. In adults with prediabetes, moderate certainty of evidence suggested reduction in the rate of progression to diabetes. Administration of high-dose intermittent vitamin D may increase falls, compared to lower-dose daily dosing. We did not identify trials on the benefits and harms of screening with serum 25(OH)D. The evidence summarized in this systematic review addresses the benefits and harms of vitamin D for the prevention of disease. The guideline panel considered additional information about individuals' and providers' values and preferences and other important decisional and contextual factors to develop clinical recommendations.

Effects of COVID-19 pandemic–associated reduction in respiratory infections on infantile asthma development

BackgroundIt is speculated that the COVID-19 pandemic associated reduction in the prevalence of respiratory tract infections has influenced on the incidence of asthma in infants. ObjectivesWe investigated an association between the reduction in viral infections and the reduction in asthma in infants. MethodsThe subjects were infants born in the early stages of the COVID-19 pandemic in Japan, which began in February 2020. A questionnaire survey related to asthma and allergy was conducted at 18 months and 3 years old. These results were compared to those of age-matched infants during the non-pandemic period. ResultsThere were no epidemics of viral infectious diseases until the target child was 18 months old. At 18 months, the incidence of asthma/asthmatic bronchitis diagnosed by physicians in pandemic infants was significantly lower than that in non-pandemic infants. In 3-year-old infants, no marked difference was observed between non-pandemic infants and pandemic infants, except for an increase in RSV infection in pandemic infants. In a comparative study of the same infants at 18 months and 3 years old, an increased prevalence of asthma/asthmatic bronchitis was observed in pandemic infants. Furthermore, the incidence of asthma after RSV infection in pandemic infants was significantly lower than that in non-pandemic infants. ConclusionThe COVID-19 pandemic-associated reduction in respiratory tract infections may have reduced the incidence of asthma in infancy, and RSV infection after 18 months old had little effect on the onset of asthma. These results indicate the importance of preventing respiratory tract infections in early infancy.

Impact of COVID-19 related lockdown on hospital admissions, hospital burden and deaths due to non- COVID illnesses in a tertiary care centre in Southern Sri Lanka

Background: Sri Lanka imposed an aggressive curfew to prevent the spread of COVID-19, which led to major changes in population behaviour. It was presumed that these measures could affect the morbidity patterns and management of other medical conditions. We aimed to study the impact of the pandemic on hospital admissions, morbidity patterns and mortality from non-COVID illnesses during the period of lockdown.Methods: A retrospective study was conducted to gather data related to all non- COVID medical admissions from four medical wards and emergency treatment unit (ETU) of the Teaching Hospital Karapitiya for a six-week period during the lockdown. Data on the total number of admissions, reasons for admission, diagnoses, duration of hospital stay and outcome including deaths were obtained. Corresponding data from the same period of the previous year (pre COVID period) were compared.Results: The total number of admissions during the pre- COVID period was 2939 and that reduced to 1491 during the lockdown period. There was a significant reduction of admissions due to infectious illnesses including respiratory tract infections (p <0.001), dengue (p= 0.01) and leptospirosis (p=0.02) during the lockdown period. There was a significant increase in requested admissions (p=0.002) including admissions for procedures, investigations, referrals and transfers. The mortality during the two periods did not change significantly (pre-covid period 5.1 %, lockdown period 4.2%, p=0.16).Conclusions: The results of the study showed that social distancing and travel restriction had a significant impact on health seeking behaviour, disease patterns and outcome. Reduction in hospital admissions and changes in disease patterns, especially reduction in respiratory tract infections could be a positive effect of preventive measures: physical distancing, wearing masks and travel restriction. Total lockdown of the country had no significant effect on total deaths as well as deaths related to NCDs.

'Stay at home': Is it good or not for house dust mite sensitized children with respiratory allergies?

Lockdown was imposed for children for 75days in Turkey to limit the spread of COVID-19. During this period, children have to stay indoors, which might probably increase their exposures to indoor allergens and pollutants. Besides, reduced exposures to respiratory tract infections and outdoor pollutants might be favorable outcomes of this lockdown period. We evaluated the effects of the lockdown on house dust mite (HDM)-sensitized children with respiratory allergies. Three-month clinical and medication data of 165 mild-moderate asthmatic children with or without allergic rhinitis (AR), who were grouped according to their HDM sensitization status, were retrieved from patient records. Demographics, asthma control tests, nasal visual analog scores, and outdoor air quality monitoring data were used for assessments in comparisons with the same period in the previous year. Eighty-four patients had asthma, and 81 patients had asthma with AR. Sensitization to HDM was present in 61.8% of the children. Patients experienced reduced numbers of upper respiratory tract infections (P=.008) and reduced asthma exacerbations (P<.001) compared with the same period in the previous year. Asthma control tests were significantly improved (P<.001), and cumulative inhaled corticosteroid usages were significantly reduced (P<.001). Noteworthily, nasal symptoms were significantly worsened in HDM-sensitized asthmatics with AR (P<.001). This study highlighted that reduction in respiratory tract infections and outdoor pollution may play roles in asthma control and prevent exacerbations despite continuous indoor allergen exposure. Besides, worsening of nasal symptoms in HDM-sensitized asthmatics with AR implies the importance of indoor avoidance measures for AR control.

Reducing the frequency of respiratory tract infections in severe neurological disorders by inhaled antibiotics: a retrospective data analysis.

BackgroundIn patients with severe neurological impairment, recurrent respiratory tract infections frequently occur as a result of impaired clearance of airway secretions and microbial airway colonisation. We hypothesised that inhaled antibiotic therapy may improve the morbidity of these patients.MethodsA retrospective data analysis of 20 patients (11 nontracheotomised and nine tracheotomised) with neurological impairment and microbial airway colonisation was carried out at a children's university hospital. Two questionnaires that asked about the number of respiratory tract infections, antibiotic therapies and hospitalisations were distributed to the patients/caregivers: a first questionnaire representing the 12 months prior to the initiation of inhaled antibiotics and a second questionnaire describing the first 12 months under therapy.ResultsDuring the first 12 months of therapy, the frequency of respiratory tract infections among all participants was reduced from a mean of 6.8 episodes (median (interquartile range (IQR)) 6.0 (4.0–10.0) episodes) to a mean of 2.5 episodes (median (IQR) 2.0 (1.0–3.0) episodes; p<0.001). In addition, a significant decrease of systemic antibiotic therapies (mean 7.7, median (IQR) 6.0 (4.0–10.0) versus 2.5, 2.5 (0.0–3.75) episodes; p<0.001) and hospitalisations (mean 3.9, median (IQR) 3.5 (1.0–5.0) versus 0.9, 0.0 (0.0–1.0) episodes; p<0.001) was noted. This significant therapeutic effect could be demonstrated in a subgroup analysis in both tracheotomised and nontracheotomised subjects. The reduction of respiratory tract infections and systemic antibiotic therapies (and thus the therapeutic success) was significantly greater in the nontracheotomised group compared with the tracheotomised group.ConclusionsThe presented data suggest that inhaled antibiotics might play a role in treating recurrent respiratory tract infections in neuromuscular diseases.

An Atole Fortified with 21 Vitamins and Minerals Improves Nutritional Status of 6 to 72 Month‐Old Children in 6 Nurseries in Guatemala City

Chispuditos® is a corn/soy atole fortified with 21 vitamins and minerals designed to reduce micronutrient deficiency of Central American children. A portion of atole (18.75g) was provided for 5 days/week to 6‐72 month‐old children. Seven hundred and forty seven children completed 1 year of the nutritional intervention. Hemoglobin, anthropometry and incidence of respiratory tract infections and diarrhea were analyzed at baseline, six months and one year. Repeated measures ANOVA indicated an increase in hemoglobin from baseline=11.76±1.17g/dL to endline=12.39±1.05 g/dL, p&lt;0.001. HAZ scores increased from ‐1.25±1.02 to ‐1.07±0.96, p&lt;0.001 over the time course of the intervention. Furthermore, there was a 57.1% reduction in respiratory tract infections, p&lt;0.001 after 12 months. No changes in the incidence of diarrhea from baseline to one year were observed. Overall, children in this study had an improvement in HAZ scores, hemoglobin concentrations and respiratory tract infections after 12 months of intervention, while previous studies in comparable settings took approximately 24 months for HAZ scores to improve.Funded by The Mathile Institute for the Advancement of Human Nutrition.

Attributable mortality of ventilator-associated pneumonia

Wilhemina Melsen and colleagues estimated the attributable mortality of ventilator-associated pneumonia from individual patient data derived from randomised prevention studies. On the basis of the search terms “ventilator-associated pneumonia” and “randomisation” the investigators identifi ed 45 trials, of which 24 were included. They state that the included studies are reliable representatives of all studies of prevention of ventilator-associated pneumonia. However, the analysis included only six decontamination studies. This point is remarkable, because a meta-analysis of 36 randomised trials concluded that treatment with a combination of topical and systemic antibiotics reduces the incidence of respiratory tract infections from 40% to 19%, and overall mortality from 30% to 24%, with four patients needed-totreat to prevent one infection, and 18 to prevent one death. From these data suggesting that a 53% reduction in respiratory tract infections leads to a 6% reduction in mortality, the attributable mortality of respiratory infections is 11%, which is similar to the 13% calculated by Melsen and colleagues. Furthermore, Melsen and colleagues state that mortality after ventilator-associated pneumonia is mainly caused by prolonged exposure to risk of death due to increased length of stay in an intensive-care unit (ICU). However, this assumption contradicts previous fi ndings. In a case-control study, Klompas and colleagues elegantly showed that ventilator-associated pneumonia signifi cantly prolonged both median duration of mechanical ventilation and median length of stay in an ICU by 6 days. However, hospital mortality did not diff er signifi cantly. Indeed, mortality is not proportional to length of ICU stay—severely ill patients dying early during their ICU admission have a shorter length of stay than do those recovering after prolonged mechanical ventilation. In a retrospective analysis of 543 mechanically ventilated patients, Hayashi and colleagues also reported signifi cantly prolonged mechanical ventilation and length of stay in an ICU without an increase in mortality in patients with ventilatorassociated complications; however, they did note that patients with ventilator-associated complications more often had chronic obstructive pulmonary disease and acute kidney injury than did those with no complications. In patients with ventilator-associated pneumonia, underlying illness and complicating organ failure could have a greater eff ect on mortality than does length of ICU stay.

For whom should we use selective decontamination of the digestive tract?

This review discusses the relevant studies on selective decontamination of the digestive tract (SDD) published between 2009 and mid-2011. In a multicenter cluster-randomized cross-over study in the Netherlands, SDD and selective oropharyngeal decontamination (SOD) were associated with higher survival at day 28, with a lower incidence of ICU-acquired bacteremia and with less acquisition of respiratory tract colonization with antibiotic resistant pathogens, compared to standard care. A post-hoc analysis of this study suggests that SDD might be more effective in surgical patients and SOD in nonsurgical patients. In a randomized study perioperative use of SDD in patients undergoing gastrointestinal surgery was associated with lower incidences of anastomotic leakages. A Cochrane meta-analysis, not including any of the before mentioned studies, reported a reduction of respiratory tract infections in studies by using topical antibiotics only and higher survival rates when topical antibiotics were combined with parenteral antibiotics. Recent studies show that in ICUs with low levels of antibiotic resistance, SDD and SOD improved patient outcome and reduced infections and carriage with antibiotic-resistant pathogens. The effect in settings with higher levels of antibiotic resistance remains to be determined as well as the efficacy of SDD and SOD in specific patient groups.

Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) occurs within 24 hours of intubation and mechanical ventilation. Health care costs related to increased patient mortality, extended length of stay, and patient well-being make treatment of VAP a priority in all health care settings. The Institute for Healthcare Improvements has developed the Ventilator Bundle as a group of interventions linked to ventilator care with demonstrated outcome improvements; removal of subglottic secretions is one of these recommendations. Dental plaque and bacterial colonization of pathogens is directly related to microaspiration of bacteria into the lungs. A moist environment in the mouth maintains normal oropharyngeal bacteria, preventing overgrowth of pathogenic bacteria. Frequent oral care to include twice-a-day brushing of the teeth found a 69% reduction in respiratory tract infections.

Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care

Pneumonia is an important cause of mortality in intensive care units (ICUs). The incidence of pneumonia in ICU 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 pneumonia, it has been shown to contribute to mortality in ICUs independently of other factors that are also strongly associated with such deaths. To assess the effects of prophylactic antibiotic regimens, such as selective decontamination of the digestive tract (SDD) for the prevention of respiratory tract infections (RTIs) and overall mortality in adults receiving intensive care. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1), which contains the Cochrane Acute Respiratory Infections (ARI) Group's Specialised Register; MEDLINE (January 1966 to March 2009); and EMBASE (January 1990 to March 2009). Randomised controlled trials (RCTs) of antibiotic prophylaxis for RTIs and deaths among adult ICU patients. At least two review authors independently extracted data and assessed trial quality. We included 36 trials involving 6914 people. There was variation in the antibiotics used, patient characteristics and risk of RTIs and mortality in the control groups. In trials comparing a combination of topical and systemic antibiotics, there was a significant reduction in both RTIs (number of studies = 16, odds ratio (OR) 0.28, 95% confidence interval (CI) 0.20 to 0.38) and total mortality (number of studies = 17, OR 0.75, 95% CI 0.65 to 0.87) in the treated group. In trials comparing topical antimicrobials alone (or comparing topical plus systemic versus systemic alone) there was a significant reduction in RTIs (number of studies = 17, OR 0.44, 95% CI 0.31 to 0.63) but not in total mortality (number of studies = 19, OR 0.97, 95% CI 0.82 to 1.16) in the treated group. A combination of topical and systemic prophylactic antibiotics reduces RTIs and overall mortality in adult patients receiving intensive care. Treatment based on the use of topical prophylaxis alone reduces respiratory infections but not mortality. The risk of resistance occurring as a negative consequence of antibiotic use was appropriately explored only in one trial which did not show any such effect.

Outcome of total splenectomy with portosystemic shunt for massive splenomegaly and variceal bleeding in cystic fibrosis

Multilobular biliary cirrhosis and portal hypertension are frequent complications of cystic fibrosis liver disease, leading to esophageal varices and splenomegaly. Therapy is focused on variceal bleeding control; however, reduction of spleen volume is also important to restore gastric volume and resolve invalidating abdominal discomfort. We report long-term follow up (median duration, 5.5 years; range, 14 months-21.5 years) of 6 patients with cystic fibrosis (4 men, 2 women; median age, 14 years; range, 8-18 years) who underwent splenectomy with a splenorenal shunt operation. Three patients received elective surgery for massive splenomegaly with important abdominal discomfort, recurrent variceal bleeding, and hypersplenism. Three were urgently treated to control variceal bleeding after several sessions of sclerotherapy. All but 2 received antipneumococcal vaccination before surgery. Four patients had a weight gain of 10% within 3 months of surgery, and 3 developed spontaneous puberty. Lung function remained stable, and there was an overall reduction of respiratory tract infections. The youngest patient, however, died of overwhelming septicemia during treatment with steroids. Although total splenectomy has important risks, in well-selected cases, it can have benefits. Immuno- and chemoprophylaxis, combined with patient awareness of supplementary risk of infections is indispensable to minimize septic complications.

Antibiotic prophylaxis to prevent nosocomial infections in patients in intensive care units: evidence that struggle to convince practising clinicians

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 pneumonia, it has been shown to contribute to mortality in intensive care units independently of other factors that are also strongly associated with such deaths. 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 the Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2003), which contains the Acute Respiratory Infections (ARI) Group specialised trials register; MEDLINE (January 1966 to September 2003); EMBASE (January 1990 to September 2003); proceedings of scientific meetings and reference lists of articles from January 1984 to December 2002. 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. At least two reviewers independently extracted data and assessed trial quality. Overall 36 trials involving 6922 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 17 trials (involving 4295 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 29% respectively. There was a significant reduction of both respiratory tract infections (odds ratio 0.35, 95% confidence interval [CI] 0.29-0.41) and total mortality (odds ratio 0.78, 95% CI 0.68-0.89) in the treated group. On average 5 patients needed to be treated to prevent one infection and 21 patients to prevent one death. In 17 trials (involving 2664 patients) that tested topical antimicrobials alone (or comparing topical plus systemic versus systemic alone) the rates of respiratory tract infections and deaths in the control groups were 30 and 26% respectively. There was a significant reduction of respiratory tract infections (odds ratio 0.52, 95% CI 0.43-0.63), but not in total mortality (odds ratio 0.97, 95% CI 0.81-1.16) in the treated group. A combination of topical and systemic prophylactic antibiotics reduces respiratory tract infections and overall mortality in adult patients receiving intensive care. A treatment based on the use of topical prophylaxis alone reduces respiratory infections, but not mortality. The risk of occurrence of resistance as a negative consequence of antibiotic use was appropriately explored only in the most recent trial by de Jonge, which did not show any such effect.

Antibiotic prophylaxis to reduce respiratory tract infections and mortality in adults receiving intensive care.

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 pneumonia, it has been shown to contribute to mortality in intensive care units independently of other factors that are also strongly associated with such deaths. 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. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (issue 3, 2003), which contains the Acute Respiratory Infections (ARI) Group specialised trials register; MEDLINE (January 1966 to September 2003); EMBASE (January 1990 to September 2003); proceedings of scientific meetings and reference lists of articles from January 1984 to December 2002. We also contacted investigators in the field. Randomised trials of antibiotic prophylaxis for respiratory tract infections and deaths among adult intensive care unit patients. At least two reviewers independently extracted data and assessed trial quality. Overall 36 trials involving 6922 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 17 trials (involving 4295 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 29% 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 0.78, 95% confidence interval 0.68 to 0.89) in the treated group. On average 5 patients needed to be treated to prevent one infection and 21 patients to prevent one death. In 17 trials (involving 2664 patients) that tested topical antimicrobials alone (or comparing topical plus systemic versus systemic alone) the rates of respiratory tract infections and deaths in the control groups were 30% and 26% respectively. There was a significant reduction of respiratory tract infections (odds ratio 0.52, 95% confidence interval 0.43 to 0.63) but not in total mortality (odds ratio 0.97, 95% confidence interval 0.81 to 1.16) in the treated group. A combination of topical and systemic prophylactic antibiotics reduces respiratory tract infections and overall mortality in adult patients receiving intensive care. A treatment based on the use of topical prophylaxis alone reduces respiratory infections but not mortality. The risk of occurrence of resistance as a negative consequence of antibiotic use was appropriately explored only in the most recent trial by de Jonge which did not show any such effect.

Antibiotics for preventing respiratory tract infections in adults receiving intensive care.

Pneumonia is an important cause of mortality in intensive care units. 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. We searched MEDLINE, proceedings of scientific meetings and reference lists of articles from January 1984 to September 1997. We also contacted investigators in the field. Randomised trials of antibiotic prophylaxis for respiratory tract infections and deaths among adult intensive care unit patients. Trials were assessed for quality and investigators contacted for additional information. Overall 33 trials involving 5727 people were included. There was variation in the antibiotics used, patient characteristics and the risk of respiratory tract infections and mortality in the control groups. In 16 trials (involving 3493 patients) of a topical and systemic antibiotic combination, the average rates of respiratory tract infections and deaths in the control group were 33% and 28% respectively. There was a significant reduction of both respiratory tract infections (odds ratio 0.36, 95% confidence interval 0.30 to 0. 43) and total mortality (odds ratio 0.80, 95% confidence interval 0. 68 to 0.93). On average five patients needed to be treated to prevent one infection and 23 treated to prevent one death. In 17 trials (involving 2366 patients) of topical antimicrobials the rates of respiratory tract infections and deaths in the control groups were 30% and 24% respectively. There was a significant reduction of respiratory tract infections (odds ratio 0.57, 95% confidence interval 0.46 to 0.69) but not in total mortality (odds ratio 1.01, 95% confidence interval 0.84 to 1.22). A combination of topical and systemic prophylactic antibiotics can reduce respiratory tract infections and overall mortality in adult patients receiving intensive care. [This abstract has been prepared centrally.]

Antibiotic prophylaxis in intensive care units: meta-analyses versus clinical practice.

At least 7 meta-analyses (MA) have been published since 1991 on the effectiveness of antibiotic prophylaxis in Intensive care units (ICU) patients, but controversy still remains about the overall effectiveness and risk-benefits profile of the treatment. This paper aims to summarise available data on effectiveness and discuss reasons why the controversy is still open and possible directions for future research. Review of available published MA on the effectiveness of various regimens of antibiotic prophylaxis with particular emphasis on the results of the individual patient data analysis published in 1998. MA or randomised control trials (RCTs), published and unpublished, conducted anywhere in the world. Unselected adult ICU populations included in studies, published and unpublished, comparing different forms of antibiotic prophylaxis. Respiratory tract infections (RTIs) - however defined in individual studies - and total mortality. General information from the 7 MAs published between 1991 and 1999 and detailed information from the MA published in the British Medical Journal in 1998 that reported data on 5727 patients enrolled in 33 RCTs; access to individual patients data could be obtained from 25 of 33 RCTs and allowed a confirmatory individual patient MA on 4343 patients. Pooled estimates from 16 RCTs (including 3361 patients) testing the effect of the topical and systemic antibiotic combination indicates a significant reduction of both RTIs (OR=0.35, 95% CI=0.29-0.41) and total mortality (OR=0.80, 95% CI=0.69-0.93). Five and 23 patients need to be treated to prevent one infection and one death, respectively, using this treatment. Pooled data from the 17 RCTs (including 2366 patients) testing the effect of a regimen based on topical antimicrobials indicated a statistically significant reduction in RTIs (OR=0.57, 95% CI=0.46-0.69) but not in total mortality (OR=1.01; 95% CI=0.84-1.22). Individual patient data analyses confirmed these results. After over 30 RCTs and seven MAs, there is strong evidence that antibiotic prophylaxis can reduce both RTIs and total mortality in ICUs patients in a statistically and clinically significant way. Concerns about the possible occurrence of antimicrobial resistance are not supported by available data but cannot, at the same time, be ruled out due to methodologic inadequacies of the studies carried out so far. Whether new trials are needed, and how they should be designed to answer the question of the potential for antibiotic resistance following widespread use of the treatment, are now the main issues to be settled. Convening an international panel of clinical experts and methodologists could be appropriate, in order to explore the best way to resolve the controversy that seems to be preventing the widespread use of a treatment that the best analysis of available data now indicates is effective.