Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis

Zhang, X; Cui, X; Jiang, M; Huang, S; Yang, M

doi:10.1016/j.jcrc.2023.154315

Sepsis & infection

Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis

J Crit CarePublished 28 Apr 2023Systematic review and meta-analysis of randomised and observational studies

Pooled resultResultOdds ratio 1.39 95% CI 0.87–2.20

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Authors' conclusion

NC was associated with better microbiological outcomes but did not result in any remarkable changes in the prognosis of patients with VAP.

Study context

Population: Patients with ventilator-associated pneumonia (VAP)7 observational studies · 3 randomized controlled trials (RCTs)

Comparison: Nebulized colistin vs intravenous antibiotic
Outcome: Clinical response

Pooled result

As reported in the abstract

Odds ratio

1.39

95% CI 0.87–2.20

NC vs Intravenous antibiotic

OR 1.39 (95% CI 0.87–2.20)

Further pooled results

Outcome	← Lower odds with NC ←→ Higher odds with NC →	OR (95% CI)
Microbiological eradication	0.20.5125	2.21 (1.25–3.92)
Overall mortality	0.20.5125	0.74 (0.50–1.12)
	0.20.5125Odds ratio (log scale)

Outcome	← Lower with NC ←→ Higher with NC →	MD (95% CI)
Length of mechanical ventilation	−10−505	−2.5 (−5.20-0.19)
ICU LOS	−10−505	−1.91 (−6.66-2.84)
	−10−505Difference (linear scale)

Safety

Outcome	← Lower odds with NC ←→ Higher odds with NC →	OR (95% CI)
Nephrotoxicity	0.050.21520	0.86 (0.60–1.23)
BronchospasmRaised significantly	0.050.21520	5.19 (1.05–25.52)
	0.050.21520Odds ratio (log scale)

Original publication

Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis. J Crit Care. Published 28 April 2023. doi:10.1016/j.jcrc.2023.154315

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