Inhaled Amikacin to Prevent Ventilator-Associated Pneumonia.
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Ehrmann Stephan, Barbier François, Demiselle Julien, Quenot Jean-Pierre, Herbrecht Jean-Etienne, Roux Damien, Lacherade Jean-Claude, Landais Mickaël, Seguin Philippe, Schnell David, Veinstein Anne, Gouin Philippe, Lasocki Sigismond, Lu Qin, Beduneau Gaëtan, Ferrandiere Martine, Plantefève Gaëtan, Dahyot-Fizelier Claire, Chebib Nader, Mercier Emmanuelle, Heuzé-Vourc'h Nathalie, Respaud Renaud, Gregoire Nicolas, Garot Denis, Nay Mai-Anh, Meziani Ferhat, Andreu Pascal, Clere-Jehl Raphaël, Zucman Noémie, Azaïs Marie-Ange, Saint-Martin Marjorie, Gandonnière Charlotte Salmon, Benzekri Dalila, Merdji Hamid, Tavernier Elsa, Reva and CRICS-TRIGGERSEP F-CRIN Research Networks
Аннотация
METHODS: In this investigator-initiated, multicenter, double-blind, randomized, controlled, superiority trial, we assigned critically ill adults who had been undergoing invasive mechanical ventilation for at least 72 hours to receive inhaled amikacin at a dose of 20 mg per kilogram of ideal body weight once daily or to receive placebo for 3 days. The primary outcome was a first episode of ventilator-associated pneumonia during 28 days of follow-up. Safety was assessed.
RESULTS: A total of 850 patients underwent randomization, and 847 were included in the analyses (417 assigned to the amikacin group and 430 to the placebo group). All three daily nebulizations were received by 337 patients (81%) in the amikacin group and 355 patients (83%) in the placebo group. At 28 days, ventilator-associated pneumonia had developed in 62 patients (15%) in the amikacin group and in 95 patients (22%) in the placebo group (difference in restricted mean survival time to ventilator-associated pneumonia, 1.5 days; 95% confidence interval [CI], 0.6 to 2.5; P = 0.004). An infection-related ventilator-associated complication occurred in 74 patients (18%) in the amikacin group and in 111 patients (26%) in the placebo group (hazard ratio, 0.66; 95% CI, 0.50 to 0.89). Trial-related serious adverse effects were seen in 7 patients (1.7%) in the amikacin group and in 4 patients (0.9%) in the placebo group.
CONCLUSIONS: Among patients who had undergone mechanical ventilation for at least 3 days, a subsequent 3-day course of inhaled amikacin reduced the burden of ventilator-associated pneumonia during 28 days of follow-up. (Funded by the French Ministry of Health; AMIKINHAL ClinicalTrials.gov number, NCT03149640; EUDRA Clinical Trials number, 2016-001054-17.).