To Give or Not to Give Inhaled Antibiotics: Heterogeneous Effects of Inhaled Antibiotics in Ventilated Patients in the Intensive Care Unit.

Background Ventilator-associated pneumonia (VAP) is one of the most common causes of morbidity and mortality in the intensive care unit (ICU). Inhaled antibiotics, which can directly target lung pathogens, have been used to treat VAP in the ICU for the past few decades. However, data on their efficacy and safety profiles remain limited. The primary objective of this study was to assess the effects of inhaled antibiotics on clinical outcomes for patients with VAP. Methods In this study, we conducted a retrospective cohort study including all patients at our Regional One Health in Memphis, TN, who were diagnosed and treated for VAP. Our overall objective was to assess the treatment efficacy of inhaled antibiotics as adjunct therapy for VAP on overall hospital length of stay (LOS), days on the ventilator, days in the intensive care unit, and respiratory culture clearance from antimicrobial agents. Results There were 383 ventilated patients diagnosed with VAP included for analysis, and 52 of those received inhaled antibiotics. The use of inhaled antibiotics for ventilated patients in the ICU was associated with shorter hospital LOS (incidence rate ratio (IRR)=0.89, 95% confidence interval (CI) 0.84-0.94, p<0.001) but no change in ICU LOS (IRR=1.05, 95% CI 0.99-1.11, p=0.11). There was no statistically significant association between the use of inhaled antibiotics and ventilator duration or respiratory culture clearance. Conclusions These findings suggest that inhaled antibiotics are likely not required for every ventilated patient in the ICU; however, more studies are needed to clarify their role in the treatment of VAP in similar patient populations.