BACKGROUND Lower respiratory tract infections are common in patients receiving invasive mechanical ventilation in an Intensive Care Unit (ICU) after an acute brain injury and may have deleterious consequences. RESEARCH QUESTION In adults with acute brain injury receiving invasive mechanical ventilation in an ICU, is the administration of prophylactic parenteral antibiotics, compared to placebo or usual care, associated with reduced mortality? STUDY DESIGN AND METHODS We conducted a systematic review and meta-analysis. We searched for randomised clinical trials (RCTs) in electronic databases, as well as unpublished trials. The primary outcome was hospital mortality, secondary outcomes included the incidence of ventilator associated pneumonia, ICU length of stay, and duration of mechanical ventilation. We used a random effects model to estimate the pooled risk ratio (RR) with corresponding 95% confidence intervals (CI) for binary outcomes and the mean difference (MD) with 95% CI for continuous outcomes. Certainty of evidence was evaluated using GRADE methods. RESULTS There were 1728 reports of studies screened, with 7 RCTs recruiting 835 participants included. No trials were adjudicated as having a high risk of bias. The pooled estimated risk ratio (RR) for mortality associated with the use of prophylactic antibiotics was 0.91 (95% CI 0.70 to 1.17, p=0.39, low certainty). The pooled estimated RR for ventilator associated pneumonia was 0.56 (95% CI 0.35 to 0.89, low certainty). The pooled estimated duration of mechanical ventilation for those allocated to prophylactic antibiotics compared to control (mean difference (MD) -2.0 days, 95% CI -6.1 to 2.1, very low certainty) and duration of ICU admission (MD -2.2 days, 95% CI -5.4 to 1.1 days, very low certainty) were similar. INTERPRETATION Current evidence from randomised clinical trials does not provide definitive evidence regarding the effect of prophylactic antibiotics on mortality in patients receiving invasive mechanical ventilation in the ICU.

中文翻译：

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在重症监护病房接受有创通气的急性脑损伤成人患者的预防性抗生素：系统评价和荟萃分析。


背景 下呼吸道感染在急性脑损伤后在重症监护病房 （ICU） 接受有创机械通气的患者中很常见，并可能产生有害后果。研究问题 在 ICU 接受有创机械通气的急性脑损伤成人患者中，与安慰剂或常规护理相比，预防性肠外抗生素治疗是否与降低死亡率有关？研究设计和方法 我们进行了系统评价和荟萃分析。我们在电子数据库中检索了随机临床试验（randomised clinical trials， RCTs）以及未发表的试验。主要结局是住院死亡率，次要结局包括呼吸机相关肺炎的发生率、 ICU 住院时间和机械通气持续时间。我们使用随机效应模型来估计二元结局的合并风险比 （RR） 和相应的 95% 置信区间 （CI），以及连续结局的平均差 （MD） 和 95% CI。使用 GRADE 方法评估证据质量。结果 筛选了 1728 份研究报告，其中 7 项 RCT 招募了 835 名参与者。没有试验被判定为具有高偏倚风险。与预防性使用抗生素相关的死亡率的合并估计风险比 （RR） 为 0.91 （95% CI 0.70 至 1.17，p = 0.39，低质量）。呼吸机相关性肺炎的合并估计 RR 为 0.56 （95% CI 0.35 至 0.89，低质量）。与对照组相比，预防性抗生素组患者的机械通气合并估计持续时间（平均差 （MD） -2.0 天，95% CI -6.1 至 2.1，极低质量）和 ICU 入住持续时间（MD -2.2 天，95% CI -5.4 至 1.1 天，极低质量）相似。 解释 目前来自随机临床试验的证据并未提供关于预防性抗生素对 ICU 接受有创机械通气患者死亡率影响的明确证据。