الفهرس 
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Abstract
Aerosolized antibiotics are being increasingly used to treat respiratory infections, especially those caused by drug-resistant pathogens. Their use in the treatment of ventilator-associated pneumonia in critically ill patients is especially significant. The current study aimed to assess the role of inhaled antimicrobials as an adjunctive therapy in the treatment of ventilator- associated pneumonia. To obtain this aim, 70 patients with VAP who were admitted to respiratory ICU at Abbassia Chest hospital were included and were divided into 2 groups according to
• Nebulizer group: consists of 35 patients who received nebulized antibiotics in addition to the IV antibiotics.
• Control group: consists of 35 patients who received IV antibiotics only as a control group.
from the current study, we can sum up the following:
• Mean age was 52.91 ± 4.55 and 52.23 ± 4.67 years in control and Nebulizer groups respectively and male % was 100% in both groups. All studied patients were smokers and were chronic steroid users. The most commonly reported organisms were Klebsiella which was reported in 40% and 25.7% of patients in control and Nebulizer groups respectively, followed by Acintobacter which was reported in 28.6% of both groups.
• Patients in the nebulizer group had significantly higher incidence of use of Levofloxacin (57.1% vs 22.9%; P=0.003) and Sulperazone (14.3% vs 0.0%; P=0.020) as well as significantly lower incidence of use of Amikacin (0% vs 57.1%), Meropenem (2.9% vs 22.9%; P=0.012), and Vancomycin (0% vs 20%; P=0.005) when compared to patients in the control group. In the nebulizer group, Amikacin was the most commonly used inhaled antibiotic in 15 (42.9%) patients, followed by Vancomycin in 12 (34.3%) patients. Ceftazidime was inhaled in 8 (22.9%) patients.
• Mean CPIS score was 8.46 ± 0.51 and 8.43 ± 0.50 in control and Nebulizer groups respectively. All patients had APCHE II score between 10 and 14. Patients in nebulizer group had significantly higher incidence of resolution of pneumonia (85.7% vs 62.9%; P=0.029), as well as significantly shorter duration of mechanical ventilation when compared to patients in the control group (10.43±3.37 vs 12.49±3.95; P=0.022). CPIS score significantly decreased after treatment in both studied groups (P<0.001 for both). While there was no significant difference between studied groups regarding pretreatment, post-treatment CPIS scores, or reduction in CPIS scores.
• Use of inhaled Amikacin and Ceftazidime was associated with higher incidence of Klebsiella infection (P=0.042) and Acintobacter infection (P=0.023). Use of inhaled Vancomycin was associated with higher incidence of MRSA infection (P=0.000).
• Patients with resolved VAP were significantly younger than patients with unresolved VAP (51.85 ± 4.53 vs 54.67 ± 4.17 years; P=0.023), and had significantly lower incidence of IHD when compared to patients with unresolved VAP (0% vs 11.1%; P=0.015). Patients with resolved VAP had significantly shorter duration of mechanical ventilation when compared to patients with unresolved VAP (10.88 ± 3.75 vs 13.11 ± 3.50 days; P=0.031), as well as significantly lower CPIS score after treatment when compared to patients with unresolved VAP (2.56 ± 0.50 vs 7.17 ± 2.62; P=0.000). Patients with resolved VAP had significantly higher reduction of CPIS score when compared to patients with unresolved VAP (5.87 ± 0.63 vs 1.33 ± 2.59; P=0.000).
• Univariate logistic regression analysis revealed that the significant predictors associated with resolution of VAP were age≤53 years (P=0.031; OR: 3.474, C.I: 1.121-10.763), and duration of mechanical ventilation ≤11 days (P=0.022; OR: 3.778, C.I: 1.215-11.746). While on multivariate logistic regression analysis, Duration of mechanical ventilation ≤11 days was the most significant predictor for resolution of VAP (P=0.040; OR: 3. 396, C.I: 1.058-10.905).