Use of nebulized antimicrobials for the treatment of respiratory infections in invasively mechanically ventilated adults: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.
Identifieur interne : 000096 ( Main/Exploration ); précédent : 000095; suivant : 000097Use of nebulized antimicrobials for the treatment of respiratory infections in invasively mechanically ventilated adults: a position paper from the European Society of Clinical Microbiology and Infectious Diseases.
Auteurs : J. Rello [Espagne] ; C. Solé-Lleonart [Suisse] ; J-J Rouby [France] ; J. Chastre [France] ; S. Blot [Belgique] ; G. Poulakou [Grèce] ; C-E Luyt [France] ; J. Riera [Espagne] ; L B Palmer [États-Unis] ; J M Pereira [Portugal] ; T. Felton [Royaume-Uni] ; J. Dhanani [Australie] ; M. Bassetti [Italie] ; T. Welte [Allemagne] ; J A Roberts [Australie]Source :
- Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [ 1469-0691 ] ; 2017.
Abstract
With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens. This Position Paper of the European Society of Clinical Microbiology and Infectious Diseases provides recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology regarding the use of nebulized antibiotics in invasively mechanically ventilated adults, based on a systematic review and meta-analysis of the existing literature (last search July 2016). Overall, the panel recommends avoiding the use of nebulized antibiotics in clinical practice, due to a weak level of evidence of their efficacy and the high potential for underestimated risks of adverse events (particularly, respiratory complications). Higher-quality evidence is urgently needed to inform clinical practice. Priorities of future research are detailed in the second part of the Position Paper as guidance for researchers in this field. In particular, the panel identified an urgent need for randomized clinical trials of nebulized antibiotic therapy as part of a substitution approach to treatment of pneumonia due to multidrug-resistant pathogens.
DOI: 10.1016/j.cmi.2017.04.011
PubMed: 28412382
Affiliations:
- Allemagne, Australie, Belgique, Espagne, France, Grèce, Italie, Portugal, Royaume-Uni, Suisse, États-Unis
- Angleterre, Attique (région), Basse-Saxe, Canton de Vaud, Catalogne, Grand Manchester, Province de Flandre-Orientale, Région flamande, État de New York, Île-de-France
- Athènes, Barcelone, Gand, Hanovre, Lausanne, Manchester, Paris
- Université de Gand
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Electronic address: jrello@crips.es.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Sole Lleonart, C" sort="Sole Lleonart, C" uniqKey="Sole Lleonart C" first="C" last="Solé-Lleonart">C. Solé-Lleonart</name><affiliation wicri:level="3"><nlm:affiliation>Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 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João EPE, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Felton, T" sort="Felton, T" uniqKey="Felton T" first="T" last="Felton">T. 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Rello</name><affiliation wicri:level="3"><nlm:affiliation>CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients, Barcelona, Spain. Electronic address: jrello@crips.es.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>CIBERES, Universitat Autonòma de Barcelona, European Study Group of Infections in Critically Ill Patients, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Sole Lleonart, C" sort="Sole Lleonart, C" uniqKey="Sole Lleonart C" first="C" last="Solé-Lleonart">C. Solé-Lleonart</name><affiliation wicri:level="3"><nlm:affiliation>Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Electronic address: pm.Nebat@gmail.com.</nlm:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Service de Médecine Intensive Adulte, Centre Hospitalier Universitaire Vaudois, Lausanne</wicri:regionArea><placeName><settlement type="city">Lausanne</settlement><region nuts="3" type="region">Canton de Vaud</region></placeName></affiliation></author><author><name sortKey="Rouby, J J" sort="Rouby, J J" uniqKey="Rouby J" first="J-J" last="Rouby">J-J Rouby</name><affiliation wicri:level="3"><nlm:affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Chastre, J" sort="Chastre, J" uniqKey="Chastre J" first="J" last="Chastre">J. Chastre</name><affiliation wicri:level="3"><nlm:affiliation>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name><affiliation wicri:level="4"><nlm:affiliation>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent, Belgium.</nlm:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Internal Medicine, Faculty of Medicine & Health Science, Ghent University, Ghent</wicri:regionArea><orgName type="university">Université de Gand</orgName><placeName><settlement type="city">Gand</settlement><region>Région flamande</region><region type="district" nuts="2">Province de Flandre-Orientale</region></placeName></affiliation></author><author><name sortKey="Poulakou, G" sort="Poulakou, G" uniqKey="Poulakou G" first="G" last="Poulakou">G. Poulakou</name><affiliation wicri:level="3"><nlm:affiliation>4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece.</nlm:affiliation><country xml:lang="fr">Grèce</country><wicri:regionArea>4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens</wicri:regionArea><placeName><settlement type="city">Athènes</settlement><region nuts="2" type="region">Attique (région)</region></placeName></affiliation></author><author><name sortKey="Luyt, C E" sort="Luyt, C E" uniqKey="Luyt C" first="C-E" last="Luyt">C-E Luyt</name><affiliation wicri:level="3"><nlm:affiliation>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie of Paris 6, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Riera, J" sort="Riera, J" uniqKey="Riera J" first="J" last="Riera">J. Riera</name><affiliation wicri:level="3"><nlm:affiliation>Clinical Research & Innovation in Pneumonia and Sepsis, Vall d'Hebron Institute of Research, CIBERES, Barcelona, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Clinical Research & Innovation in Pneumonia and Sepsis, Vall d'Hebron Institute of Research, CIBERES, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Palmer, L B" sort="Palmer, L B" uniqKey="Palmer L" first="L B" last="Palmer">L B Palmer</name><affiliation wicri:level="2"><nlm:affiliation>Pulmonary, Critical Care and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Pulmonary, Critical Care and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY</wicri:regionArea><placeName><region type="state">État de New York</region></placeName></affiliation></author><author><name sortKey="Pereira, J M" sort="Pereira, J M" uniqKey="Pereira J" first="J M" last="Pereira">J M Pereira</name><affiliation wicri:level="1"><nlm:affiliation>Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.</nlm:affiliation><country xml:lang="fr">Portugal</country><wicri:regionArea>Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto</wicri:regionArea><wicri:noRegion>Porto</wicri:noRegion></affiliation></author><author><name sortKey="Felton, T" sort="Felton, T" uniqKey="Felton T" first="T" last="Felton">T. Felton</name><affiliation wicri:level="3"><nlm:affiliation>Acute Intensive Care Unit, University Hospital of South Manchester, Manchester, United Kingdom.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Acute Intensive Care Unit, University Hospital of South Manchester, Manchester</wicri:regionArea><placeName><settlement type="city">Manchester</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Manchester</region></placeName></affiliation></author><author><name sortKey="Dhanani, J" sort="Dhanani, J" uniqKey="Dhanani J" first="J" last="Dhanani">J. Dhanani</name><affiliation wicri:level="1"><nlm:affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane</wicri:regionArea><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author><author><name sortKey="Bassetti, M" sort="Bassetti, M" uniqKey="Bassetti M" first="M" last="Bassetti">M. Bassetti</name><affiliation wicri:level="1"><nlm:affiliation>Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.</nlm:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine</wicri:regionArea><wicri:noRegion>Udine</wicri:noRegion></affiliation></author><author><name sortKey="Welte, T" sort="Welte, T" uniqKey="Welte T" first="T" last="Welte">T. Welte</name><affiliation wicri:level="3"><nlm:affiliation>German Centre for Lung Research (DZL), Department of Respiratory Medicine, Medizinische Hochschule, Hannover, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>German Centre for Lung Research (DZL), Department of Respiratory Medicine, Medizinische Hochschule, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Roberts, J A" sort="Roberts, J A" uniqKey="Roberts J" first="J A" last="Roberts">J A Roberts</name><affiliation wicri:level="1"><nlm:affiliation>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Burns Trauma and Critical Care Research Centre and Centre for Translational Anti-infective Pharmacodynamics, The University of Queensland, Butterfield Street, Herston, Brisbane</wicri:regionArea><wicri:noRegion>Brisbane</wicri:noRegion></affiliation></author></analytic><series><title level="j">Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases</title><idno type="eISSN">1469-0691</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">With an established role in cystic fibrosis and bronchiectasis, nebulized antibiotics are increasingly being used to treat respiratory infections in critically ill invasively mechanically ventilated adult patients. Although there is limited evidence describing their efficacy and safety, in an era when there is a need for new strategies to enhance antibiotic effectiveness because of a shortage of new agents and increases in antibiotic resistance, the potential of nebulization of antibiotics to optimize therapy is considered of high interest, particularly in patients infected with multidrug-resistant pathogens. This Position Paper of the European Society of Clinical Microbiology and Infectious Diseases provides recommendations based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology regarding the use of nebulized antibiotics in invasively mechanically ventilated adults, based on a systematic review and meta-analysis of the existing literature (last search July 2016). Overall, the panel recommends avoiding the use of nebulized antibiotics in clinical practice, due to a weak level of evidence of their efficacy and the high potential for underestimated risks of adverse events (particularly, respiratory complications). Higher-quality evidence is urgently needed to inform clinical practice. Priorities of future research are detailed in the second part of the Position Paper as guidance for researchers in this field. In particular, the panel identified an urgent need for randomized clinical trials of nebulized antibiotic therapy as part of a substitution approach to treatment of pneumonia due to multidrug-resistant pathogens.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Belgique</li><li>Espagne</li><li>France</li><li>Grèce</li><li>Italie</li><li>Portugal</li><li>Royaume-Uni</li><li>Suisse</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Attique (région)</li><li>Basse-Saxe</li><li>Canton de Vaud</li><li>Catalogne</li><li>Grand Manchester</li><li>Province de Flandre-Orientale</li><li>Région flamande</li><li>État de New York</li><li>Île-de-France</li></region><settlement><li>Athènes</li><li>Barcelone</li><li>Gand</li><li>Hanovre</li><li>Lausanne</li><li>Manchester</li><li>Paris</li></settlement><orgName><li>Université de Gand</li></orgName></list><tree><country name="Espagne"><region name="Catalogne"><name sortKey="Rello, J" sort="Rello, J" uniqKey="Rello J" first="J" last="Rello">J. Rello</name></region><name sortKey="Riera, J" sort="Riera, J" uniqKey="Riera J" first="J" last="Riera">J. Riera</name></country><country name="Suisse"><region name="Canton de Vaud"><name sortKey="Sole Lleonart, C" sort="Sole Lleonart, C" uniqKey="Sole Lleonart C" first="C" last="Solé-Lleonart">C. Solé-Lleonart</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Rouby, J J" sort="Rouby, J J" uniqKey="Rouby J" first="J-J" last="Rouby">J-J Rouby</name></region><name sortKey="Chastre, J" sort="Chastre, J" uniqKey="Chastre J" first="J" last="Chastre">J. Chastre</name><name sortKey="Luyt, C E" sort="Luyt, C E" uniqKey="Luyt C" first="C-E" last="Luyt">C-E Luyt</name></country><country name="Belgique"><region name="Région flamande"><name sortKey="Blot, S" sort="Blot, S" uniqKey="Blot S" first="S" last="Blot">S. Blot</name></region></country><country name="Grèce"><region name="Attique (région)"><name sortKey="Poulakou, G" sort="Poulakou, G" uniqKey="Poulakou G" first="G" last="Poulakou">G. Poulakou</name></region></country><country name="États-Unis"><region name="État de New York"><name sortKey="Palmer, L B" sort="Palmer, L B" uniqKey="Palmer L" first="L B" last="Palmer">L B Palmer</name></region></country><country name="Portugal"><noRegion><name sortKey="Pereira, J M" sort="Pereira, J M" uniqKey="Pereira J" first="J M" last="Pereira">J M Pereira</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Felton, T" sort="Felton, T" uniqKey="Felton T" first="T" last="Felton">T. Felton</name></region></country><country name="Australie"><noRegion><name sortKey="Dhanani, J" sort="Dhanani, J" uniqKey="Dhanani J" first="J" last="Dhanani">J. Dhanani</name></noRegion><name sortKey="Roberts, J A" sort="Roberts, J A" uniqKey="Roberts J" first="J A" last="Roberts">J A Roberts</name></country><country name="Italie"><noRegion><name sortKey="Bassetti, M" sort="Bassetti, M" uniqKey="Bassetti M" first="M" last="Bassetti">M. Bassetti</name></noRegion></country><country name="Allemagne"><region name="Basse-Saxe"><name sortKey="Welte, T" sort="Welte, T" uniqKey="Welte T" first="T" last="Welte">T. Welte</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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