From: Nebulized antibiotics for ventilator-associated pneumonia: a systematic review and meta-analysis
Study, year | Clinical cure criteria | Microbiological cure criteria | Adverse events assessed |
---|---|---|---|
Observational studies | Â | Â | Â |
 Doshi, 2013 [21] | Resolution of initial signs and symptoms of infection, including normalization of white blood cell count and temperature, by the end of therapy. | Eradication of the MDR pathogen on subsequent respiratory cultures | NA |
 Ghannam, 2009 [22] | Improved clinical parameters (fever defervescence, suctioning requirements, symptoms and signs of pneumonia), ventilator parameters and laboratory findings (improved blood gases, normalization of white blood cell count), and/or receding pulmonary infiltrates on a chest radiograph at the end of therapy. | Eradication of causative organisms in patients in whom a follow-up culture was obtained at the end of therapy. | Renal dysfunction (doubling of serum creatinine in patients with pretreatment (baseline) creatinine clearance of ≥30 ml/minute or an increase in creatinine by ≥1 mg/dl at the end of therapy in patients with pretreatment creatinine clearance <30 ml/minute) |
 Kalin, 2012 [23] | Resolution of symptoms and signs of VAP at the end of the therapy | Eradication of MDR A. baumannii on follow-up culture | Renal toxicity (RIFLE criteria) |
 Kofteridis, 2010 [24] | Resolution of presenting symptoms and signs of infection by the end of colistin treatment | Eradication of the pathogen at the end of antimicrobial therapy or at discharge from ICU | Renal toxicity (serum creatinine value >2 mg/dl; reduction in the calculated creatinine clearance of 50%, compared with the value at the start of treatment; or as a decline in renal function that prompted renal replacement therapy; increase of 150% of the baseline creatinine, a reduction in the calculated creatinine clearance of 50% relative to the value at therapy initiation in patients with pre-existing renal dysfunction), bronchoconstriction, cough, apnea, or chest tightness, and arterial hypoxemia. |
 Korbila, 2010 [29] | Normalization of temperature and tracheal secretions, together with a return to baseline of the white blood cell count and the C-reactive protein level, and the improvement in chest X-ray appearances, by the end of treatment. | NA | NA |
 Tumbarello, 2013 [31] | Resolution of all signs and symptoms of pneumonia and improvement or lack of progression of all chest radiograph abnormalities when colistin was discontinued | Disappearance of the infecting bacterium from post-treatment respiratory samples | Acute kidney injury (a greater than twofold increase in serum creatinine or a ≥50% decrease in the glomerular filtration rate or oliguria (output <0.5 ml/kg/hour) for ≥12 hours) |
Randomized controlled trials | Â | Â | |
 Hallal, 2007 [25] | Extubation within the study period, improving of MODS, resolution of fever, pulmonary infiltrates and physical signs of pneumonia. | NA | Doubling of the serum creatinine concentration or an increase of creatinine above 2 mg/dl at any timea |
 Le Conte, 2000 [26] | Extubation within 10 days | NA | Respiratory tolerance (described in results section as hypoxemia during nebulization) and evolution of serum creatinine |
 Lu, 2011 [27] | Reduction of clinical and biological signs of infection, decrease in modified clinical pulmonary infection score below 6, significant lung CT re-aeration, and lower respiratory tract specimens either sterile or with nonsignificant concentrations of P. aeruginosa | Eradication of P. aeruginosa in a lower respiratory specimens after 8 days of antimicrobial therapy | Bronchospasm, hypoxemia, obstruction of expiratory filter |
 Niederman, 2012 [28] | Complete or partial resolution of signs and symptoms of pneumonia, improvement or lack of progression of abnormalities on chest X-ray, and no additional intravenous antibiotics since completion of treatment | Confirmed eradication of the original pathogen or presumed eradication in patients with complete or partial resolution of pneumonia | Septic shock, seizures and bronchospasm. |
 Palmer, 2014 [30] | NA | No growth in culture and no visible organisms seen on Gram-stain of an organism identified at randomization | New resistant to antimicrobial therapy |
 Rattanaumpawan, 2010 [32] | Complete resolution of all signs and symptoms of pneumonia, and improvement or lack of progression of all abnormalities on the chest radiograph | Eradication or presumed eradication after antimicrobial treatment | Renal impairment (a rise of 2 mg/dl in the serum creatinine level of patients with previously normal renal function or a doubling of the baseline serum creatinine level in patients with pre-existing renal insufficiency), bronchospasm. |