Aerosolized Colistin for the Treatment of Multidrug-resistant Acinetobacter baumannii Pneumonia: Experience in a Tertiary Care Hospital in Northern Taiwan

Lin, Cheng-Chih; Liu, Te-Chu; Kuo, Chen-Feng; Liu, Chang-Pan; Lee, Chun-Ming

doi:10.1016/s1684-1182(10)60050-3

Cited by 50 publications

(28 citation statements)

References 30 publications

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“…In contrast, nebulizing polymyxins has the potential to achieve very high concentrations in the lungs while minimizing systemic exposure and toxicity. Numerous investigators have described favorable outcomes of patients with nonbacteremic Acinetobacter pneumonia who were treated with nebulized polymyxins (252)(253)(254)(255)(256)(257)(258)(259)(260)(261). In one case-control study, use of inhaled colistin increased microbial eradication rate from the airways in ventilated patients compared to systemic therapy (257).…”

Section: Current Treatment Optionsmentioning

confidence: 99%

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

et al. 2017

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SUMMARY Acinetobacter is a complex genus, and historically, there has been confusion about the existence of multiple species. The species commonly cause nosocomial infections, predominantly aspiration pneumonia and catheter-associated bacteremia, but can also cause soft tissue and urinary tract infections. Community-acquired infections by Acinetobacter spp. are increasingly reported. Transmission of Acinetobacter and subsequent disease is facilitated by the organism's environmental tenacity, resistance to desiccation, and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. primarily stem from evasion of rapid clearance by the innate immune system, effectively enabling high bacterial density that triggers lipopolysaccharide (LPS)–Toll-like receptor 4 (TLR4)-mediated sepsis. Capsular polysaccharide is a critical virulence factor that enables immune evasion, while LPS triggers septic shock. However, the primary driver of clinical outcome is antibiotic resistance. Administration of initially effective therapy is key to improving survival, reducing 30-day mortality threefold. Regrettably, due to the high frequency of this organism having an extreme drug resistance (XDR) phenotype, early initiation of effective therapy is a major clinical challenge. Given its high rate of antibiotic resistance and abysmal outcomes (up to 70% mortality rate from infections caused by XDR strains in some case series), new preventative and therapeutic options for Acinetobacter spp. are desperately needed.

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Section: Current Treatment Optionsmentioning

confidence: 99%

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

et al. 2017

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“…Colistin is a member of the polymyxin family and was first discovered in the 1950s [27,30]. It has a concentration-dependent bactericidal mechanism and binds to the anionic lipopolysaccharide molecule by displacing calcium and magnesium in the outer cell membrane of gram-negative bacteria.…”

Section: Introductionmentioning

confidence: 99%

Outcome of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa treated with aerosolized colistin in neonates: a retrospective chart review

et al. 2011

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Multidrug-resistant (MDR) gram-negative bacteriarelated nosocomial infections and ventilator-associated pneumonia (VAP) presents an emerging challenge to clinicians. Older antimicrobial agents such as colistin have become life-saving drugs because of the susceptibility of these pathogens. We report our experience with aerosolized colistin in two preterm and one term neonate with Acinetobacter baumannii and Pseudomonas aeruginosa-related VAP who were unresponsiveness to previous antimicrobial treatment. All pathogens were isolated from tracheal aspirate. We used 5 mg/kg (base activity) aerosolized colistin methanesulfonate sodium in every 12 h as an adjunctive therapy for VAP. VAP was treated by 14, 14, and 16-day courses of aerosolized colistin in these patients, respectively. No adverse effect such as nephrotoxicity or neurotoxicity was observed. We found that aerosolized colistin was tolerable and safe, and it may be an adjunctive treatment option for MDR gramnegative bacterial VAP in neonates. Further studies are needed to determine appropriate doses for aerosolized colistin and its eligibility as an alternative treatment choice in newborns.

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“…There was no significant clinical adverse effect for inhalational colistin (94)(95)(96), but in addition to intravenous colistin, the results were conflicted. Kalin G et al suggested that inhalational colistin increased the nephrotoxicity risk, however, a recent study found no difference in nephrotoxicity risk with additional inhalational colistin therapy (33).…”

Section: Nephrotoxicitymentioning

confidence: 96%

Intravenous polymyxins: Revival with puzzle

Fei

et al. 2017

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Aerosolized Colistin for the Treatment of Multidrug-resistant Acinetobacter baumannii Pneumonia: Experience in a Tertiary Care Hospital in Northern Taiwan

Abstract: Aerosolized colistin may be considered as an adjunct to intravenous treatments in patients with VAP due to colistin-susceptible MDR A. baumannii in critically ill patients.

Cited by 50 publications

References 30 publications

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

Outcome of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa treated with aerosolized colistin in neonates: a retrospective chart review

Intravenous polymyxins: Revival with puzzle

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