{"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":1789726359419,"version":"4.0.1"},"reference-count":29,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T00:00:00Z","timestamp":1734048000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To evaluate the efficacy and safety of prophylactic nebulized antibiotics in preventing intensive care unit (ICU)-acquired pneumonia through a meta-analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Randomized controlled trials (RCTs) investigating the potential reduction in the incidence of ICU-acquired pneumonia through prophylactic nebulized antibiotics were collected by searching the PubMed, Embase, and Cochrane Library databases from their inception to January 23, 2024. The primary endpoint was the incidence of ICU-acquired pneumonia, while the secondary endpoints included mortality, length of ICU stay, mechanical ventilation days, and nebulization-related side effects. Statistical analyses were performed using RevMan 5.3 and STATA 14.0 software.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A total of six RCTs were included in the analysis, involving 1,287 patients (636 patients in the study group received prophylactic antibiotic therapy, including Polymyxin B, Tobramycin, Ceftazidime, Colistimethate sodium, and amikacin; 651 patients in the control group primarily received saline). The results indicated that prophylactic nebulized antibiotic therapy significantly reduced the incidence of ICU-acquired pneumonia compared to that in the control group (odds ratio (OR) = 0.57, 95% confidence interval (CI) [0.43\u20130.74], <jats:italic>P<\/jats:italic> &lt; 0.0001). No significant difference was observed in the mortality rate between the treatment and control groups (OR = 0.86, 95% CI [0.68\u20131.10], <jats:italic>P<\/jats:italic> = 0.24). Prophylactic nebulized antibiotic therapy also did not significantly reduce the length of ICU stay (MD = 0.2 days; 95% CI [\u22120.81 to 1.20], <jats:italic>P<\/jats:italic> = 0.70) or the number of mechanical ventilation days (MD = 0.43 days; 95% CI [\u22120.47 to 1.33], <jats:italic>P<\/jats:italic> = 0.35). Additionally, there was no evidence that prophylactic nebulized antibiotic therapy contributed to the development of multiple drug-resistant (MDR) bacterial pneumonia or increased the incidence of associated side effects, such as airway spasms.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>This meta-analysis suggests that ICU-acquired pneumonia can be prevented by prophylactic nebulized antibiotic therapy in critically ill patients without increasing the risk of MDR bacterial infections or airway spasms. However, the reduction in the incidence of ICU-acquired pneumonia did not result in significant improvements in mortality or length of ICU stay.<\/jats:p>\n<\/jats:sec>","DOI":"10.7717\/peerj.18686","type":"journal-article","created":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T09:11:31Z","timestamp":1734081091000},"page":"e18686","source":"Crossref","is-referenced-by-count":4,"title":["Effects of prophylactic nebulized antibiotics on the prevention of ICU-acquired pneumonia: a systematic review and meta-analysis"],"prefix":"10.7717","volume":"12","author":[{"given":"Ming","family":"Gao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxu","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxuan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2024,12,13]]},"reference":[{"issue":"2","key":"10.7717\/peerj.18686\/ref-1","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1097\/CCM.0000000000002736","article-title":"Prevention of ventilator-associated pneumonia: the multimodal approach of the Spanish ICU \u201cPneumonia Zero\u201d program","volume":"46","author":"\u00c1lvarez-Lerma","year":"2018","journal-title":"Critical Care Medicine"},{"issue":"9","key":"10.7717\/peerj.18686\/ref-2","first-page":"1492","article-title":"Treatment of Klebsiella pneumoniae respiratory tract infection of squirrel monkeys with aerosol administration of kanamycin","volume":"41","author":"Berendt","year":"1980","journal-title":"American Journal of Veterinary Research"},{"issue":"1","key":"10.7717\/peerj.18686\/ref-3","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1089\/sur.2006.042","article-title":"Aerosolized ceftazidime prophylaxis against ventilator-associated pneumonia in high-risk trauma patients: results of a double-blind randomized study","volume":"8","author":"Claridge","year":"2007","journal-title":"Surgical Infections"},{"issue":"4","key":"10.7717\/peerj.18686\/ref-4","doi-asserted-by":"publisher","first-page":"305","DOI":"10.7326\/0003-4819-141-4-200408170-00011","article-title":"Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia","volume":"141","author":"Dodek","year":"2004","journal-title":"Annals of Internal Medicine"},{"issue":"22","key":"10.7717\/peerj.18686\/ref-5","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1056\/NEJMoa2310307","article-title":"Inhaled amikacin to prevent ventilator-associated pneumonia","volume":"389","author":"Ehrmann","year":"2023","journal-title":"New England Journal of Medicine"},{"issue":"4","key":"10.7717\/peerj.18686\/ref-6","doi-asserted-by":"publisher","first-page":"R123","DOI":"10.1186\/cc5032","article-title":"Administration of antibiotics via the respiratory tract for the prevention of ICU-acquired pneumonia: a meta-analysis of comparative trials","volume":"10","author":"Falagas","year":"2006","journal-title":"Critical Care"},{"issue":"10","key":"10.7717\/peerj.18686\/ref-7","doi-asserted-by":"publisher","first-page":"1792","DOI":"10.1007\/s00134-009-1605-2","article-title":"Nebulized ceftazidime in experimental pneumonia caused by partially resistant Pseudomonas aeruginosa","volume":"35","author":"Ferrari","year":"2009","journal-title":"Intensive Care Medicine"},{"issue":"11","key":"10.7717\/peerj.18686\/ref-8","doi-asserted-by":"publisher","first-page":"2935","DOI":"10.1172\/JCI107490","article-title":"Prevention of gram-negative bacillary pneumonia using aerosol polymyxin as prophylaxis. 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