Effectiveness of Antibiotic Prophylaxis in Preventing Ventilator-Associated Pneumonia in Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis

Introduction: Ventilator-associated pneumonia (VAP) is a significant complication in patients with acute brain injury (ABI), contributing to increased morbidity and mortality. This systematic review and meta-analysis evaluated the effectiveness of antibiotic prophylaxis in preventing VAP in ABI patients.

Methods: A systematic search was conducted across PubMed, Cochrane Library, and Web of Science databases. Studies reporting on antibiotic prophylaxis for VAP prevention in ABI patients were included. Primary outcomes were early-onset VAP, late-onset VAP, overall VAP incidence, and mortality. Secondary outcomes included duration of mechanical ventilation and ICU length of stay.

Results: Ten studies met inclusion criteria, comprising 1,843 patients. Antibiotic prophylaxis significantly reduced overall VAP risk (RR=0.56, 95% CI: 0.41-0.78, P< 0.001) and early-onset VAP (RR=0.40, 95% CI: 0.28-0.56, P< 0.001). No significant effect was observed for late-onset VAP (RR=1.06, 95% CI: 0.59-1.88, P=0.85). Prophylaxis was associated with reduced ICU length of stay (SMD=-0.28, 95% CI: -0.46 to -0.10, P< 0.01). A trend towards decreased ICU mortality was observed but did not reach statistical significance (RR=0.80, 95% CI: 0.63-1.03, P=0.09). Mechanical ventilation duration showed a non-significant trend towards reduction (SMD=-0.21, 95% CI: -0.46 to 0.04, P=0.10).

Conclusion : Antibiotic prophylaxis effectively reduces early-onset VAP and overall VAP incidence in ABI patients, with associated reductions in ICU length of stay. However, it shows no benefit in preventing late-onset VAP. These findings support considering prophylactic antibiotics in ABI patients while emphasizing the need for careful patient selection and antimicrobial stewardship.