Inhaled Amikacin May Reduce Ventilator-Associated Pneumonia Risk

A recent multicenter, double-blind, randomised controlled trial suggests that a 3-day course of inhaled amikacin, administered to critically ill patients who have undergone mechanical ventilation for at least 3 days, may significantly reduce the risk of ventilator-associated pneumonia (VAP).

This study was published in The New England Journal Of Medicine by Stephan Ehrmann and colleagues. The study included 847 critically ill adults. Patients in the amikacin group received a daily dose of 20 mg per kilogram of ideal body weight. Inhaled amikacin or placebo was administered for 3 days. The majority of patients in both groups received all three daily nebulizations, ensuring proper adherence to the treatment protocol.

Ventilator-associated pneumonia (VAP) is a common and serious complication in critically ill patients on mechanical ventilation, but preventive measures have been unclear until now. The study, which included 847 patients, found the following key results:

• Reduced Incidence of VAP: Inhaled amikacin administration for 3 days led to a significant reduction in the incidence of VAP. At 28 days, VAP occurred in 15% of the amikacin group compared to 22% in the placebo group.
  
• Improved Survival Time: The use of inhaled amikacin increased the restricted mean survival time without VAP by 1.5 days during the 28-day follow-up period.
  
• Fewer Complications: Patients receiving inhaled amikacin experienced fewer infection-related ventilator-associated complications, with a hazard ratio of 0.66, indicating a 34% reduced risk.
  
• Safety Profile: The study reported a low rate of serious adverse effects related to the treatment, making inhaled amikacin a well-tolerated intervention.

These findings are promising for reducing the burden of VAP, improving outcomes in critically ill patients undergoing mechanical ventilation.This study provides evidence of an effective preventive measure for VAP in mechanically ventilated patients. Reduced rates of VAP can lead to shorter hospital stays, lower healthcare costs, and improved patient outcomes. Clinicians and healthcare providers should consider the potential benefits of inhaled amikacin in reducing VAP incidence in their critically ill patients.

Reference:

Ehrmann, S., Barbier, F., Demiselle, J., Quenot, J.-P., Herbrecht, J.-E., Roux, D., Lacherade, J.-C., Landais, M., Seguin, P., Schnell, D., Veinstein, A., Gouin, P., Lasocki, S., Lu, Q., Beduneau, G., Ferrandiere, M., Plantefève, G., Dahyot-Fizelier, C., Chebib, N., … Tavernier, E. Inhaled amikacin to prevent ventilator-associated pneumonia. The New England Journal of Medicine,2023. https://doi.org/10.1056/nejmoa2310307