ALLICIN AS ADJUNCTIVE ANTIBIOTIC IN THE TREATMENT OF VENTILATOR-ASSOCIATED PNEUMONIA PATIENTS CAUSED BY BACTERIAL INFECTION

FANG YAN¹, FANG YANG¹, LI LI¹, FUJUN MA², JING ZHANG¹, GUI ZHOU³, NI CHEN¹, YANCHUN CHEN, PING WANG¹

¹Department of Intensive Care Medicine, Chengdu Fifth People’s hospital, Sichuan, Chin - ²Department of Discipline Management Office, Chengdu Fifth People’s hospital, Sichuan, China - ³Department of Hospital infection Management, Chengdu Fifth People’s hospital, Sichuan, China

Introduction: Ventilator-associated pneumonia (VAP) is a frequent hospital-acquired infection, it occurs in up to 20% of patients that require at least 48 hours of mechanical ventilation. Significant variation in rates of death have been observed in clinical trials and observational analyses. It extends the length of ICU stay and places a high ecological burden in terms of antibiotic use. Allicin is the active component of garlic, it has also been shown to have antimicrobial and anti-inflammatory properties. Whereas, the efficacy of gar- lic in the treatment of VAP is still unknown.

Objective: We conducted this study to explore whether allicin could reduce the duration of antibiotic use or shorten the length of stay in the ICU for the population of patients with ventilator-associated pneumonia caused by bacterial infection in Chinese people.

Materials and methods: One hundred and thirty-three patients with ventilator-associated pneumonia caused by bacterial infec- tion admitted to Chengdu Fifth People’s hospital from January 2011 to December 2017 were included in this prospective, single center, cohort study. Allicin injection was added on the basis of antibiotics. Then they were randomly divided into two groups, with 63 cases in the treatment group and 70 cases in the control group. The control group was treated with antibiotics on the basis of conventional the- rapy, while the treatment group was given allicin injection for 14 days on the basis of the control group. Distribution of pathogenic bac- teria were analyzed. Length of mechanical ventilation, the duration of antibiotic use, the length of stay in the ICU and 14-day mortality were compared between both groups. The safety and drug-induced adverse reactions of all the patients were also monitored during the treatment. The diagnosis of VAP was based on the definition of the basis of national guidelines from the Chinese Thoracic Society.

Results: Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pneumoniae were the most common pathogens in VAP patients caused by bacterial infection. There were no signifificant differences between two groups in the basic data and APACHEII score (P>0.05). The mechnical ventilation time in the allicin group was slightly shorter compared with the control group(days:16.55±5.41 VS 19.63±5.02,P= 0.3048), but it had no statistical significance. The duration of antibiotic use in the allicin group was 16.55±5.41 (days), while it was 19.63±5.02 (days) in the control group. It was significantly shorter than that in the control group(t=3.4053, P= 0.0009).The length of ICU stay was also statistically different (days: 19.04±7.71 vs 22.30±7.15,P=0.0126). But the 14-day mortality was no difference in the two groups.

Discussion: Allicin reduced the duration of antibiotic use and also shorten the length of ICU stay in the population of patients with ventilator-associated pneumonia caused by bacterial infection. Statistical differences were not observed in 14-day mortality outco- mes. Allicin appears to be a potential adjunctive antibiotic therapeutic drug in the treatment of ventilator-associated pneumonia patients caused by bacterial infection.