Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study

Rosa, David de la; Martínez-García, Miguel-Ángel; Barreiro, Esther; Huguet, Eva Tabernero; Solà, Roser; García-Clemente, M; Jiménez, Nuria Celorrio; Pons, Laura; Acuña, Carmen Calero; Hermosa, Juan Luis Rodríguez; Golpe, Rafael; Quintas, Raquel Dacal; Sánchez-Cuéllar, Silvia; Arroyo, Irene Torres; Aparicio, Marina Blanco; Pacheco, Virginia Almadana; Miravitlles, Marc

doi:10.1016/j.arbres.2021.03.009

Cited by 29 publications

(15 citation statements)

References 33 publications

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“…These results suggest that it is not the isolation of PA, but rather its persistence, ie, CBI by PA, which is associated with poor outcomes in COPD and provides the basis for the investigation of CBI in every patient in whom PA is isolated. 2 , 30 On the other hand, these data suggest that effective eradication of PA in patients with CBI may potentially be associated with increased survival 31 , 32 although future prospective studies are required to confirm this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…On one hand, it highlights once again the important role of bacterial infection in COPD even in stable state, outside of periods of exacerbation and, therefore, suggests the need for microbiological monitoring of sputum particularly in severe COPD patients with frequent exacerbations. 2 , 33 There is limited evidence so far about the efficacy of antimicrobial therapy in CBI, outside of periods of exacerbation, 32 , 34 but antimicrobial therapy is indicated if PA is isolated in the context of bronchiectasis. 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

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Long-Term Risk of Mortality Associated with Isolation of Pseudomonas aeruginosa in COPD: A Systematic Review and Meta-Analysis

Martínez-García¹,

Rigau²,

Barrecheguren³

et al. 2022

COPD

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Background: Chronic bronchial infection is frequent in chronic obstructive pulmonary disease (COPD), but the impact of the isolation of pathogenic bacteria, and in particular Pseudomonas aeruginosa (PA) in respiratory samples on the prognosis of COPD is unclear. Methods: We conducted a systematic review of prognostic studies including patients with isolation of PA in sputum in stable state or during exacerbations of COPD. The main outcomes were all-cause mortality, respiratory mortality, and number and severity of future exacerbations. Data were expressed as hazard ratio (HR) (95% confidence interval [CI]) whenever possible. Results: Of 2773 studies, eight were finally included (23,228 individuals). The mean age ranged from 65.5 to 73 years. Six studies reported data for all-cause mortality. The adjusted risk of death was almost double in patients with PA isolation (HR 1.95, 95% CI, 1.34 to 2.84; quality of evidence moderate). Patients with PA isolation showed a three times higher adjusted risk of readmission at 30 days after discharge (OR 3.60, 95% CI, 3.60 to 12.03, 1 study; quality of evidence very low), and more than double adjusted risk of death and hospitalization at two years (HR 2.80, 95% CI, 2.20 to 3.56, 1 study; quality of evidence very low). Conclusion:There is moderate certainty that the isolation of PA in sputum is associated with an adjusted increased risk of death in patients with COPD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Risk of Mortality Associated with Isolation of Pseudomonas aeruginosa in COPD: A Systematic Review and Meta-Analysis

Martínez-García¹,

Rigau²,

Barrecheguren³

et al. 2022

COPD

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“…Inhaled antibiotics appear to be an effective and safe treatment in COPD patients who are frequent exacerbators and in those with chronic bronchial infection sustained by any potentially pathogenic microorganism, regardless of the presence of bronchiectasis ( De la Rosa Carrillo et al., 2021 ).…”

Section: Attempts To Interfere With the Possible Infectious Component...mentioning

confidence: 99%

The future of inhalation therapy in chronic obstructive pulmonary disease

Cazzola

Ora²,

Calzetta³

et al. 2022

Current Research in Pharmacology and Drug Discovery

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“… Patients with colistin presented a lower proportion of withdrawals from treatment, less difficulty in using the device, and a smaller proportion of resistances to P. aeruginosa than patients under tobramycin treatment. de la Rosa-Carrillo, D Spain 2021 64 Multicenter, retrospective cohort study. To describe the effectiveness and safety of inhaled antibiotics in COPD patients, as well as the patient profile in which they are usually prescribed and the patient groups that can most benefit from this treatment.…”

Section: Efficacy and Safety Of Colistin In Patients With Bronchiectasismentioning

confidence: 99%

Inhaled Colistimethate Sodium in the Management of Patients with Bronchiectasis Infected by Pseudomonas aeruginosa: A Narrative Review of Current Evidence

Rosa¹,

Suárez-Cuartín²,

Golpe³

et al. 2022

IDR

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International guidelines on the treatment of bronchiectasis indicate that the use of inhaled antibiotics is effective, especially in symptomatic chronic bronchial infection (CBI) due to Pseudomonas aeruginosa (PA). To date, however, no such treatment has been approved by regulatory agencies. Of the inhaled antibiotics on the market, colistimethate sodium (colistin) is one of the most used in many countries, either in its nebulized presentation or as dry powder. Among the characteristics of this antibiotic, it is worth noting that its main target is the lipopolysaccharide in the outer membrane of the cell wall of gram-negative bacteria and that it has a low rate of resistance to PA (<1%). Most observational studies have shown that the use of colistin in patients with bronchiectasis and CBI due to PA results in a decrease in both the number and severity of exacerbations, an improvement in quality of life, a decrease in sputum volume and purulence, and a high rate of PA eradication, although there are no clear differences with respect to other inhaled antibiotics. However, the lack of randomized clinical trials (RCT) with positive results for its main variable (exacerbations) in an intention-to-treat analysis has prevented its approval by regulatory agencies as a formal indication for use in bronchiectasis. The PROMIS program, made up of two RCT with identical methodology, is currently underway. The first of these RCT (already concluded) has demonstrated a clearly positive effect on the group randomized to colistin in its main variable (number of annual exacerbations), while the results of the second are still pending. This review presents exhaustive information on the pharmacological and microbiological characteristics of colistin, the results of the studies carried out to date, and the future challenges associated with this treatment.

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Effectiveness and Safety of Inhaled Antibiotics in Patients With Chronic Obstructive Pulmonary Disease. A Multicentre Observational Study

Cited by 29 publications

References 33 publications

Long-Term Risk of Mortality Associated with Isolation of Pseudomonas aeruginosa in COPD: A Systematic Review and Meta-Analysis

Long-Term Risk of Mortality Associated with Isolation of Pseudomonas aeruginosa in COPD: A Systematic Review and Meta-Analysis

The future of inhalation therapy in chronic obstructive pulmonary disease

Inhaled Colistimethate Sodium in the Management of Patients with Bronchiectasis Infected by Pseudomonas aeruginosa: A Narrative Review of Current Evidence

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