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

Rello, J., Sole-Lleonart, C., Rouby, J. -J., Chastre, J., Blot, S., Poulakou, G., Luyt, C. -E., Riera, J., Palmer, L. B., Pereira, J. M., Felton, T., Dhanani, J., Bassetti, M., Welte, T. and Roberts, J. A. (2017) 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. Clinical Microbiology and Infection, 23 9: 629-639. doi:10.1016/j.cmi.2017.04.011

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Author Rello, J.
Sole-Lleonart, C.
Rouby, J. -J.
Chastre, J.
Blot, S.
Poulakou, G.
Luyt, C. -E.
Riera, J.
Palmer, L. B.
Pereira, J. M.
Felton, T.
Dhanani, J.
Bassetti, M.
Welte, T.
Roberts, J. A.
Title 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
Journal name Clinical Microbiology and Infection   Check publisher's open access policy
ISSN 1198-743X
1469-0691
Publication date 2017-09-01
Year available 2017
Sub-type Article (original research)
DOI 10.1016/j.cmi.2017.04.011
Open Access Status File (Author Post-print)
Volume 23
Issue 9
Start page 629
End page 639
Total pages 11
Place of publication Langford Lane, Oxford, United Kingdom
Publisher Elsevier
Language eng
Subject 2726 Microbiology (medical)
2725 Infectious Diseases
Abstract 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.
Keyword Lung-Tissue Concentrations
Beta-Lactam Monotherapy
Critically-Ill Patients
Gram-Negative Bacteria
Intensive-Care-Unit
Aerosolized Antibiotics
Pseudomonas-Aeruginosa
Adjunctive Treatment
Combination Therapy
Healthy Lungs
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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