Inhaled Amikacin Versus Placebo in Patients With Ventilator-associated Tracheobronchitis

Inclusion criteria: * Age ≥ 18 years * Admission to a participating intensive care unit (ICU) * Invasive mechanical ventilation \> 48 hours * First episode of ventilator-associated tracheobronchitis during the ICU stay defined using the following criteria: (i) purulent tracheobronchial secretions, (iii) no new or progressive persistent pulmonary infiltrate on chest X-ray, and (iv) bacterial growth on endotracheal aspirate ≥10.5 colony-forming unit (CFU)/mL or on bronchoalveolar lavage ≥10.4 CFU/mL or on plugging telescopic catheter ≥10.3 CFU/mL * Coverage by the French health insurance system (Social Security) * Written informed consent obtained from the patient, or, if the patient is not able to give written consent, from his or her legally designated representative (trusted person designated by the patient or, failing that, a family member) or, failing that, inclusion performed by the investigator within the therapeutic window (in such cases, informed consent will be sought by the investigator from the patient, or his or her legally designated representative, whichever is sooner). In all cases, the patient's written informed consent will be obtained as soon as possible. * For woman of childbearing potential: negative pregnancy test result at the time of inclusion Exclusion criteria: * Previous ventilator-associated pneumonia due to the pathogens responsible for ventilator-associated tracheobronchitis during the same ICU stay * On-going antimicrobial therapy fpr ventilator-associated pneumonia * Ventilator-associated tracheobronchitis due to pathogens with intrinsic amikacin resistance (e.g. Stenotrophomonas maltophilia) * On-going therapy with intravenous amikacin or another aminoglycoside * Acute kidney injury stage 2 or 3 of the Kidney Disease Improving Global Outcomes (KDIGO) classification and/or advanced chronic kidney failure (glomerular filtration rate \<30 mL/min), except in patients under renal replacement therapy * Grade B or C cirrhosis (Child-Pugh classification) * Scheduled extubation within 24h * Prior tracheotomy * Administration of inhaled antibiotics within the 7 preceding days * Known hypersensitivity to amikacin, another aminoglycoside, or any of the excipients * Myasthenia gravis * Contraindication to nebulization * On-going treatment with ataluren * Persons covered by articles L1121-5 to L1121-8 of the French Public Health Code (corresponding to all protected persons: pregnant women, parturients, nursing mothers, persons deprived of their liberty by judicial or administrative decision, minors, and persons subject to a legal protection measure: guardianship or trusteeship). * Moribund patient * End-of-life decision * Previous inclusion in the present study * Participation to another interventional study * Inability of the patient, or the person providing consent, to understand all aspects of the research * Patient being a relative of the investigator or a relative of someone from the team directly involved in the trial, including doctors and pharmacists