Aerosolized plus intravenous colistin vs intravenous colistin alone for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria: A retrospective cohort study

Abstract

To compare the effectiveness and safety of aerosolized (AER) plus intravenous (IV) colistin with IV colistin alone in patients with nosocomial pneumonia (NP) due to multidrug-resistant (MDR) Gramnegative bacteria. Methods: This was a retrospective cohort study of adults with NP who received IV colistin alone or in combination with AER colistin. The primary endpoint was clinical cure at end of therapy. Secondary endpoints included microbiological eradication, in-hospital mortality and nephrotoxicity. Results: In total, 135 patients were included in this study: 65 patients received AER plus IV colistin and 70 patients received IV colistin alone. Baseline characteristics were similar between the two groups. Clinical cure was achieved in 42 (65%) patients who received AER plus IV colistin and 26 (37%) patients who received IV colistin alone (P = 0.01). Among a total of 88 patients who were microbiologically evaluable, 27 (42%) patients who received AER plus IV colistin and 12 (17%) patients who received IV colistin alone attained favourable microbiological outcomes (P = 0.022). In-hospital mortality (43% vs 59%, P = 0.072) was higher in patients who received IV colistin alone, but the difference was not significant. Renal injury occurred in 31% of patients who received AER plus IV colistin and in 41% of patients who received IV colistin alone (P = 0.198). Conclusion: AER colistin can be considered as salvage therapy as an adjunct to IV administration for the treatment of patients with NP due to MDR Gram-negative pathogens.

Efficacy and safety of intravenous combined with aerosolised polymyxin versus intravenous polymyxin alone in the treatment of multidrug-resistant gram-negative bacterial pneumonia: A systematic review and meta-analysis

“…Table 1 displays the detailed baseline characteristics. A total of 16 studies [ [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] ] were included. All of the included studies were published between 2009 and 2021.…”

Ceftazidime-Avibactam versus Colistin for the Treatment of Infections Due to Carbapenem-Resistant Enterobacterales: A Multicenter Cohort Study

“…Most common comorbid conditions included hypertension (n = 137; 60%), diabetes (n = 118; 51%), endocrine disorder (n = 69; 30%), and cerebrovascular diseases (n = 63; 27%). The median (IQR) CCI was 5 (3)(4)(5)(6)(7). A total of 146 (65%) were in the ICU, 111 (48%) were on mechanical ventilation.…”

“…Before 2015, intravenous (IV) colistin was among the few frontline regimens for the treatment of infections due to CRE. However, the use of IV colistin was limited by suboptimal pharmacokinetics, 4 , 5 high rate of nephrotoxicity, 6 , 7 dosing complexity, and concerns regarding the accuracy of in vitro susceptibility testing. 8 , 9 …”

“…Before 2015, intravenous (IV) colistin was among the few frontline regimens for the treatment of infections due to CRE. However, the use of IV colistin was limited by suboptimal pharmacokinetics, 4,5 high rate of nephrotoxicity, 6,7 dosing complexity, and concerns regarding the accuracy of in vitro susceptibility testing. 8,9 In 2015, the US Food and Drug Administration approved ceftazidime-avibactam (CAZ-AVI) for the treatment of complicated intra-abdominal infections (cIAIs), complicated urinary tract infections (cUTIs) and later for hospitalacquired and ventilator-associated bacterial pneumonia (HABP/VABP).…”

Efficacy and safety of polymyxin E sulfate in the treatment of critically ill patients with carbapenem-resistant organism infections

“…Numerous clinical efficacy rates on CMS and PBS varied from 45% to 88% ( 29 ) and 47.3% to 76% ( 9 ), respectively. Regarding the parameters impacting the efficacy of the other two medications, the loading dose ( 30 – 32 ), maintenance dose ( 33 , 34 ), and time of drug administration ( 35 , 36 ), dosing regimen ( 33 , 37 – 39 ), and combination of other agents ( 40 , 41 ) were the primary areas of concern. In the present investigation, the timing of PES administration, the loading dose, the shape of the loading dose, the mode of administration, and the type of combination were not significantly associated with efficacy based on the suggested maintenance dose.…”