{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T15:53:07Z","timestamp":1781884387745,"version":"3.54.5"},"reference-count":31,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T00:00:00Z","timestamp":1781827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Background: Early-onset ventilator-associated pneumonia (EO-VAP) is a frequent complication in comatose patients requiring endotracheal intubation. This systematic review and Bayesian meta-analysis assesses the effectiveness of antibiotic prophylaxis in preventing EO-VAP in this population. Methods: Randomized controlled trials (RCTs) and observational studies enrolling adult comatose patients (GCS \u2264 8) requiring endotracheal intubation and reporting EO-VAP incidence, late-onset VAP, ICU mortality, 28-day mortality, or ICU length of stay were included. Studies without a control group or not focused on comatose patients were excluded. Following PRISMA 2020 guidelines, a comprehensive search was conducted across three databases from inception to 31 March 2026. Risk of bias was assessed using the RoB2 tool for RCTs and the ROBINS-I tool for observational studies. Results: In accordance with Cochrane Handbook recommendations, only RCTs were included in the quantitative analysis. Five RCTs (735 patients) demonstrated a significant reduction in EO-VAP incidence with antibiotic prophylaxis (RR 0.46 [95% CI: 0.35\u20130.59], p = 0.001, I2 = 0%), with the strongest effect in neurological patients (RR 0.41 [95% CI: 0.32\u20130.53], NNT = 5.4). No significant effect on mortality was demonstrated. Bayesian analysis confirmed these findings (posterior median RR 0.44 [95% CrI: 0.33\u20130.59], P(benefit) = 100%). Limitations: The analysis was limited by the small number of RCTs and the absence of data on antimicrobial resistance. Conclusions: Antibiotic prophylaxis reduces EO-VAP incidence in comatose patients, particularly neurological patients. A general recommendation cannot currently be made pending further evidence on mortality and antimicrobial resistance. Registration: This systematic review was prospectively registered on PROSPERO (CRD42024580280).<\/jats:p>","DOI":"10.3390\/antibiotics15060622","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T14:37:42Z","timestamp":1781879862000},"page":"622","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Antibiotic Prophylaxis in Comatose Patients to Prevent Early-Onset Ventilator-Associated Pneumonia: A Systematic Review and Bayesian Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7305-0797","authenticated-orcid":false,"given":"Riccardo","family":"Antolini","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, via Tronto 10\/A, 60126 Ancona, Italy"},{"name":"Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Violini","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, via Tronto 10\/A, 60126 Ancona, Italy"},{"name":"Cardiac Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4091-9674","authenticated-orcid":false,"given":"Roberta","family":"Domizi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, via Tronto 10\/A, 60126 Ancona, Italy"},{"name":"Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Damiani","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, via Tronto 10\/A, 60126 Ancona, Italy"},{"name":"Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica","family":"Adrario","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, via Tronto 10\/A, 60126 Ancona, Italy"},{"name":"Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6792-8741","authenticated-orcid":false,"given":"Abele","family":"Donati","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, via Tronto 10\/A, 60126 Ancona, Italy"},{"name":"Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Carsetti","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences and Public Health, Universit\u00e0 Politecnica delle Marche, via Tronto 10\/A, 60126 Ancona, Italy"},{"name":"Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, via Conca 71, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1097\/01.ccm.0000435665.07446.50","article-title":"Prevalence, risk factors, and mortality for ventilator-associated pneumonia in middle-aged, old, and very old critically ill patients","volume":"42","author":"Blot","year":"2014","journal-title":"Crit. 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