β-lactam antibiotics to prevent ventilator-associated pneumonia (VAP) in coma patients: A systematic review and meta-analysis of randomized controlled trials.

Objective: To evaluate the effect of parenteral β-lactam antibiotics on outcomes related to ventilator-associated pneumonia (VAP) in adult patients in coma due to acute brain injury (ABI).

Methods: Systematic review and meta-analysis. Methods: Randomized controlled trials (RCTs) published up toSeptember 30, 2024. Methods: Adult patients in coma due to ABI. Methods: Parenteral β-lactam antibiotics. Methods: Incidence and outcomes related to VAP.

Results: Three RCTs involving 483 patients met inclusion criteria; 231 patients received β-lactam prophylaxis. Among these, there were 115 cases of early-onset VAP (EO-VAP), 49 of late-onset VAP (LO-VAP), and 102 deaths. All studies were conducted in Europe. Causes of coma included trauma, stroke, and CO poisoning. Intravenous β-lactams (ampicillin/sulbactam, cefuroxime, and ceftriaxone) reduced EO-VAP risk by 57% (RR 0.43; 95% CI 0.30-0.61), and all-VAP by 35% (RR 0.65; 95% CI 0.53-0.80). No impact was observed on LO-VAP (RR 0.95; 95% CI 0.54-1.67), 28-day mortality (RR 0.76; 95% CI 0.53-1.09), intubation duration (SMD -0.13; 95% CI -0.46-0.21), or ICU length of stay (SMD -0.22; 95% CI -0.55-0.12). Heterogeneity and the risk of bias were low, with high overall evidence certainty.

Conclusions: In adult patients in coma due to ABI, intravenous β-lactam antibiotics reduce EO-VAP and all-VAP risk.