Inhaled Antibiotics to Treat Ventilator-Associated Pneumonia: A Systematic Review and Meta-Analysis
Lyu S et al., 2026 · 32 studies included
Summary
Primary synthesis of 32 randomized trials; 41 nonrandomized studies were used in sensitivity analyses.
Conclusion
Versus placebo/no adjunct, cure improved (RR 1.24, 95% CI 1.07–1.43) and mortality may have fallen (RR 0.84, 0.71–0.98), with population-dependent effects. This does not establish routine use across pathogens, nebulizers or systemic regimens, or superiority to optimized modern IV therapy.
Clinical Context & Relevant Topics (2)
Disease ReferenceMolecular resistance mechanisms (ESBL, AmpC, KPC, NDM, OXA-48, DTR-Pseudomonas, CRAB), the MERINO trial, and modern novel beta-lactamase inhibitor therapeutics.
Quantitative lower tract sampling (ETA vs BAL), rapid multiplex PCR panels and stewardship interpretation, PK/PD extended beta-lactams, 7-day duration, and the SHEA prevention bundle.