The Role of Systemic Antibiotics in Preventing Ventilator-associated Pneumonia in Intensive Care Unit Patients: Insights from a Systematic Review and Meta-analysis

The effectiveness of prophylactic systemic antibiotics in preventing ventilator-associated pneumonia (VAP) in patients receiving invasive mechanical ventilation (IMV) in intensive care units (ICUs) remains uncertain. This meta-analysis aims to evaluate the efficacy of antibiotic prophylaxis in reducing the incidence of VAP among the IMV population. We conducted an extensive search of databases, including PubMed, Web of Science, Embase, and the Cochrane Library, from their inception to December 2023. We aimed to identify studies evaluating the effects of prophylactic systemic antibiotics on VAP, early- and late-onset VAP, mortality rates, median ventilation days, and lengths of ICU and hospital stays, facilitating a comprehensive meta-analysis. Seven studies involving 939 patients indicated that the use of preventive antibiotics reduced VAP compared to control groups (risk ratio [RR] of 0.61). The early-onset VAP rate was also lower in the treatment group compared to the control groups (RR of 0.40). Prophylactic systemic antibiotics may effectively reduce VAP incidence in ICU patients on IMV but do not significantly impact other clinical outcomes. These findings may stem from the fact that VAP accounts for a small fraction of ICU deaths, and most studies focused on early-onset VAP, which has lower mortality. However, definitive recommendations cannot be established without the necessity of well-designed randomized controlled trials.