ArticleThe Journal of antimicrobial chemotherapy2025
Estimating the herd effects of antimicrobial prevention interventions on ventilator-associated pneumonia within ICU populations: a cluster randomized trial emulation using data from Cochrane reviews.
Article in The Journal of antimicrobial chemotherapy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
5 citing papers in PubMed.
- Are arms-based methods required to test the stable unit treatment value assumption (SUTVA) among Cochrane reviews of contagious infection prevention interventions?Global epidemiology · 2026Article
- Arms-Based Meta-Analysis of Microbiological Endpoints of 88 VAP Prevention Studies Using Antimicrobial Versus Non-Antimicrobial Strategies-Towards 'VAP-Zero'?Antibiotics (Basel, Switzerland) · 2026Article
- Systematic reviews and the Journal of Antimicrobial Chemotherapy; past, present and future. A systematic reappraisal.The Journal of antimicrobial chemotherapy · 2025Article
- Testing the Stable Unit Treatment Variance Assumption (SUTVA) Within Cochrane Reviews of Antimicrobial-Based Pneumonia Prevention Interventions Among Mechanically Ventilated Patients Using Caterpillar Plots.Journal of clinical medicine · 2025Article
- Associations Between Candida andMicroorganisms · 2025Article
Corrections and comments
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Authors and funding
1 author.
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Abstract
backgroundThe herd effects of antimicrobial interventions used to prevent ICU-acquired infections are unknown. The objective here was to estimate these herd effects within a single three-tiered cluster randomized trial (CRT) emulated using ventilator-associated pneumonia (VAP) data from randomized concurrent control trials (RCCTs) abstracted within Cochrane reviews.
methodsControl and intervention group data derived from 13 Cochrane reviews of 72 RCCTs of antibiotic (Tier 3) and antiseptic (Tier 2) decontamination versus 109 RCCTs of various non-decontamination (Tier 1, serving as benchmark) VAP prevention interventions were arranged as a three-tiered CRT. The direct and indirect (herd) effects of Tiers 2 and 3 each versus Tier 1 interventions were obtained using estimators derived in meta-regression models.
resultsBenchmark (Tier 1) VAP incidences derived for control and intervention groups from non-decontamination RCCTs were 23.3 (95% CI: 20.6-26.1; n = 111) and 19.2 (95% CI: 16.8-21.8; n = 112), respectively. The mean VAP incidences for antibiotic and antiseptic decontamination control groups were 5% to 15% higher than the control group benchmark. The direct effects of antibiotic and antiseptic interventions versus Tier 1 benchmarks (ORs) were 0.77 (95% CI: 0.55-1.09) and 0.97 (95% CI: 0.71-1.33) whereas the indirect effects were 2.17 (95% CI: 1.56-3.03) and 1.38 (95% CI: 1.0-1.91), respectively.
conclusionsIndirect (herd) effects from antimicrobial interventions, although inapparent within individual RCCTs, are strong. These effects on control group VAP incidences, which spuriously conflate the appearance of benefit, constitute herd peril.
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