{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:12:39Z","timestamp":1789726359550,"version":"4.0.1"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T00:00:00Z","timestamp":1714608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Ventilator-associated pneumonia (VAP) presents a significant challenge in intensive care units (ICUs). Nebulized antibiotics, particularly colistin and tobramycin, are commonly prescribed for VAP patients. However, the appropriateness of using inhaled antibiotics for VAP remains a subject of debate among experts. This study aims to provide updated insights on the efficacy of adjunctive inhaled colistin and tobramycin through a comprehensive systematic review and meta-analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A thorough search was conducted in MEDLINE, EMBASE, LILACS, COCHRANE Central, and clinical trials databases (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">www.clinicaltrials.gov<\/jats:ext-link>) from inception to June 2023. Randomized controlled trials (RCTs) meeting specific inclusion criteria were selected for analysis. These criteria included mechanically ventilated patients diagnosed with VAP, intervention with inhaled Colistin and Tobramycin compared to intravenous antibiotics, and reported outcomes such as clinical cure, microbiological eradication, mortality, or adverse events.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The initial search yielded 106 records, from which only seven RCTs fulfilled the predefined inclusion criteria. The meta-analysis revealed a higher likelihood of achieving both clinical and microbiological cure in the groups receiving tobramycin or colistin compared to the control group. The relative risk (RR) for clinical cure was 1.23 (95% CI: 1.04, 1.45), and for microbiological cure, it was 1.64 (95% CI: 1.31, 2.06). However, there were no significant differences in mortality or the probability of adverse events between the groups.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Adjunctive inhaled tobramycin or colistin may have a positive impact on the clinical and microbiological cure rates of VAP. However, the overall quality of evidence is low, indicating a high level of uncertainty. These findings underscore the need for further rigorous and well-designed studies to enhance the quality of evidence and provide more robust guidance for clinical decision-making in the management of VAP.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12890-024-03032-7","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T07:02:14Z","timestamp":1714633334000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Efficacy of adjunctive inhaled colistin and tobramycin for ventilator-associated pneumonia: systematic review and meta-analysis"],"prefix":"10.1186","volume":"24","author":[{"given":"Jefferson Antonio","family":"Buend\u00eda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Guerrero Pati\u00f1o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9s Felipe","family":"Zuluaga Salazar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,2]]},"reference":[{"issue":"5","key":"3032_CR1","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1177\/08850666221133318","volume":"38","author":"W Qi","year":"2023","unstructured":"Qi W, Murphy TE, Doyle MM, Ferrante LE. Association between daily average of mobility achieved during physical therapy sessions and hospital-acquired or ventilator-associated pneumonia among critically ill patients. J Intensive Care Med. 2023;38(5):418\u201324.","journal-title":"J Intensive Care Med"},{"issue":"1","key":"3032_CR2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.17843\/rpmesp.2023.401.12377","volume":"40","author":"LA Rodriguez-Chavez","year":"2023","unstructured":"Rodriguez-Chavez LA, Esteban-Dionicio ML, Rodriguez-Mendoza CRE. Microbiological profile of bacteria causing ventilator-associated pneumonia in the intensive care unit of a high-complexity hospital. Rev Peru Med Exp Salud Publica. 2023;40(1):115\u20137.","journal-title":"Rev Peru Med Exp Salud Publica"},{"issue":"2","key":"3032_CR3","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1055\/s-0041-1740340","volume":"43","author":"M Boisson","year":"2022","unstructured":"Boisson M, Bougle A, Sole-Lleonart C, Dhanani J, Arvaniti K, Rello J, et al. Nebulized antibiotics for healthcare- and ventilator-associated pneumonia. Semin Respir Crit Care Med. 2022;43(2):255\u201370.","journal-title":"Semin Respir Crit Care Med"},{"issue":"6","key":"3032_CR4","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.3390\/microorganisms9061154","volume":"9","author":"Y Zhu","year":"2021","unstructured":"Zhu Y, Monsel A, Roberts JA, Pontikis K, Mimoz O, Rello J, et al. Nebulized colistin in ventilator-associated pneumonia and tracheobronchitis: historical background, pharmacokinetics and perspectives. Microorganisms. 2021;9(6):1154.","journal-title":"Microorganisms."},{"issue":"3","key":"3032_CR5","doi-asserted-by":"publisher","first-page":"1700582","DOI":"10.1183\/13993003.00582-2017","volume":"50","author":"A Torres","year":"2017","unstructured":"Torres A, Niederman MS, Chastre J, Ewig S, Fernandez-Vandellos P, Hanberger H, et al. International ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: guidelines for the management of hospital-acquired pneumonia (HAP)\/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociacion Latinoamericana del Torax (ALAT). Eur Respir J. 2017;50(3):1700582.","journal-title":"Eur Respir J."},{"key":"3032_CR6","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3389\/fmed.2019.00099","volume":"6","author":"MS Niederman","year":"2019","unstructured":"Niederman MS. Adjunctive nebulized antibiotics: what is their place in ICU infections? Front Med (Lausanne). 2019;6:99.","journal-title":"Front Med (Lausanne)"},{"key":"3032_CR7","doi-asserted-by":"publisher","first-page":"154315","DOI":"10.1016\/j.jcrc.2023.154315","volume":"77","author":"X Zhang","year":"2023","unstructured":"Zhang X, Cui X, Jiang M, Huang S, Yang M. Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: a systematic review and meta-analysis. J Crit Care. 2023;77:154315.","journal-title":"J Crit Care"},{"key":"3032_CR8","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.jcrc.2021.06.004","volume":"65","author":"R Tang","year":"2021","unstructured":"Tang R, Luo R, Wu B, Wang F, Song H, Chen X. Effectiveness and safety of adjunctive inhaled antibiotics for ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials. J Crit Care. 2021;65:133\u20139.","journal-title":"J Crit Care"},{"key":"3032_CR9","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/j.jcrc.2017.09.019","volume":"43","author":"FCC Povoa","year":"2018","unstructured":"Povoa FCC, Cardinal-Fernandez P, Maia IS, Reboredo MM, Pinheiro BV. Effect of antibiotics administered via the respiratory tract in the prevention of ventilator-associated pneumonia: a systematic review and meta-analysis. J Crit Care. 2018;43:240\u20135.","journal-title":"J Crit Care"},{"key":"3032_CR10","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1186\/s12890-016-0202-8","volume":"16","author":"CJ Russell","year":"2016","unstructured":"Russell CJ, Shiroishi MS, Siantz E, Wu BW, Patino CM. The use of inhaled antibiotic therapy in the treatment of ventilator-associated pneumonia and tracheobronchitis: a systematic review. BMC Pulm Med. 2016;16:40.","journal-title":"BMC Pulm Med"},{"issue":"1","key":"3032_CR11","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1089\/jamp.2021.0023","volume":"35","author":"LB Palmer","year":"2022","unstructured":"Palmer LB, Smaldone GC. The unfulfilled promise of inhaled therapy in ventilator-associated infections: where do we go from here? J Aerosol Med Pulm Drug Deliv. 2022;35(1):11\u201324.","journal-title":"J Aerosol Med Pulm Drug Deliv"},{"key":"3032_CR12","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","volume":"343","author":"JP Higgins","year":"2011","unstructured":"Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane collaboration\u2019s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.","journal-title":"BMJ"},{"issue":"7650","key":"3032_CR13","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","volume":"336","author":"GH Guyatt","year":"2008","unstructured":"Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924\u20136.","journal-title":"BMJ"},{"issue":"5","key":"3032_CR14","doi-asserted-by":"publisher","first-page":"101249","DOI":"10.1016\/j.accpm.2023.101249","volume":"42","author":"S Angermair","year":"2023","unstructured":"Angermair S, Deja M, Thronicke A, Grehn C, Akbari N, Uhrig A, et al. A prospective phase IIA multicenter double-blinded randomized placebo-controlled clinical trial evaluating the efficacy and safety of inhaled Tobramycin in patients with ventilator-associated pneumonia (iToVAP). Anaesth Crit Care Pain Med. 2023;42(5):101249.","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"2","key":"3032_CR15","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1128\/AAC.34.2.269","volume":"34","author":"RB Brown","year":"1990","unstructured":"Brown RB, Kruse JA, Counts GW, Russell JA, Christou NV, Sands ML. Double-blind study of endotracheal tobramycin in the treatment of Gram-negative bacterial pneumonia. The endotracheal tobramycin study group. Antimicrob Agents Chemother. 1990;34(2):269\u201372.","journal-title":"Antimicrob Agents Chemother."},{"issue":"1","key":"3032_CR16","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1089\/sur.2006.051","volume":"8","author":"A Hallal","year":"2007","unstructured":"Hallal A, Cohn SM, Namias N, Habib F, Baracco G, Manning RJ, et al. Aerosolized tobramycin in the treatment of ventilator-associated pneumonia: a pilot study. Surg Infect (Larchmt). 2007;8(1):73\u201382.","journal-title":"Surg Infect (Larchmt)"},{"issue":"2","key":"3032_CR17","first-page":"76","volume":"29","author":"P Le Conte","year":"2000","unstructured":"Le Conte P, Potel G, Clementi E, Legras A, Villers D, Bironneau E, et al. Administration of tobramycin aerosols in patients with nosocomial pneumonia: a preliminary study. Presse Med. 2000;29(2):76\u20138.","journal-title":"Presse Med"},{"key":"3032_CR18","unstructured":"Nassar YS, Saber-Ayad M, Shash RY. Combined microbiological and clinical outcomes of short-term inhaled colistin adjunctive therapy in ventilator-associated pneumonia. Egypt J Chest Dis Tuberc. 2018;67(4):376\u201383."},{"issue":"12","key":"3032_CR19","doi-asserted-by":"publisher","first-page":"2645","DOI":"10.1093\/jac\/dkq360","volume":"65","author":"P Rattanaumpawan","year":"2010","unstructured":"Rattanaumpawan P, Lorsutthitham J, Ungprasert P, Angkasekwinai N, Thamlikitkul V. Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother. 2010;65(12):2645\u20139.","journal-title":"J Antimicrob Chemother"},{"issue":"3","key":"3032_CR20","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1007\/s00134-019-05914-5","volume":"46","author":"J Stokker","year":"2020","unstructured":"Stokker J, Karami M, Hoek R, Gommers D, van der Eerden M. Effect of adjunctive tobramycin inhalation versus placebo on early clinical response in the treatment of ventilator-associated pneumonia: the VAPORISE randomized-controlled trial. Intensive Care Med. 2020;46(3):546\u20138.","journal-title":"Intensive Care Med"},{"issue":"1","key":"3032_CR21","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s13054-018-2106-x","volume":"22","author":"F Xu","year":"2018","unstructured":"Xu F, He LL, Che LQ, Li W, Ying SM, Chen ZH, Shen HH. Aerosolized antibiotics for ventilator-associated pneumonia: a pairwise and Bayesian network meta-analysis. Crit Care. 2018;22(1):301.","journal-title":"Crit Care"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-024-03032-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-024-03032-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-024-03032-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T07:02:18Z","timestamp":1714633338000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-024-03032-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,2]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["3032"],"URL":"https:\/\/doi.org\/10.1186\/s12890-024-03032-7","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,2]]},"assertion":[{"value":"14 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Review Board of University of Antioquia. The need for Informed consent was waived by an Institutional Review Board of University of Antioquia (2015\u20134690), following local regulations of resolution 8430\/93, because this is a study which all information was extracted from the literature and do not use data from patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"213"}}