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Review by Marin H Kollef
University School of Medicine, St Louis, Missouri, USA
Empiric antibiotic therapy for suspected ventilator-associated pneumonia: a systematic review and meta-analysis of randomized trials.
Aarts M-AW, Hancock JN, Heyland D, et al. Crit Care Med 2008;36:108–117.
Ventilator-associated pneumonia (VAP) is a major cause of morbidity and mortality worldwide among hospitalised patients and several studies have shown that inappropriate initial antimicrobial therapy and delayed appropriate treatment of VAP are associated with greater morbidity and hospital mortality. In this summary, Marin Kollef examines this meta-analysis and review of several randomised studies, which concluded that – unlike many other analyses – the type of therapy did not influence outcomes in patients with VAP. Professor Kollef gives his view of the topic, why the authors may have come to this conclusion, and considers why not all meta-analyses are the same. This review highlights numerous important aspects that should be borne in mind when evaluating the results of studies on appropriate therapy in VAP and other serious infections.

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