title: Prevalence of Gram-negative bacteria in ventilator-associated pneumonia in neonatal intensive care units: a systematic review and meta-analysis protocol.
abstract: Ventilator-associated pneumonia (VAP) is a common and potentially lethal problem among mechanically ventilated neonates in neonatal intensive care units (NICUs). The main pathogenic bacteria of VAP in NICUs are Gram-negative pathogens, which show a general decline in sensitivities to commonly used antibiotics, but their true prevalence is not known.
  
  
  
  We aim to provide a systematic review of studies measuring the prevalence of Gram-negative bacteria in VAP in NICUs. We will search PubMed, SCOPUS, EMBASE and the ISI Web of Science, as well as the Google Scholar search engine with no restriction on language. Full copies of articles will be identified by a defined search strategy and will be considered for inclusion against predefined criteria. Study selection and data extraction will be performed by 2 independent reviewers. Statistical analysis will include the identification of data sources and documentation of estimates, as well as the application of the random-effects and fixed-effects meta-analysis models. This will allow us to aggregate prevalence estimates and account for between-study variability in calculating the overall pooled estimates and 95% CI for the prevalence of Gram-negative bacteria in VAP in NICUs. Heterogeneity will be evaluated using the I2and χ2statistical tests to determine the extent of variation in effect estimates due to heterogeneity rather than chance. Publication bias and data synthesis will be assessed by funnel plots and Begg's and Egger's tests using STATA software V.13. This systematic review protocol was prepared according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses Protocols (PRISMA-P) 2015 Statement.
  
  
  
  No ethical issues are predicted. These findings will be published in a peer-reviewed journal and presented at national and international conferences.
  
  
  
  CRD42016036048.
authors.affiliation: Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Yousef
authors.initials: Y
authors.lastname: Erfani
authors.affiliation: Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Arezoo
authors.initials: A
authors.lastname: Rasti
authors.affiliation: Department of Biostatistics, School of Public health, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Janani
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D006090:Gram-Negative Bacteria / Q000472:pathogenicity*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D000078202:Systematic Reviews as Topic; D015201:Meta-Analysis as Topic
chemical_list: D000900:Anti-Bacterial Agents
keywords: Gram Negative bacteria; NICU; Systematic Review; Ventilator Associated Pneumonia