Effectiveness of adjunctive nebulized antibiotics in critically ill patients with respiratory tract infections

Abstract

The purpose of the study was to analyze the effectiveness of adding nebulized antibiotics to systemic antimicrobials in critically ill patients with respiratory tract infections (pneumonia or tracheobronchitis) and the effect on renal function. A retrospective observational cohort study including critically ill patients with respiratory tract infections during a 2-year period was conducted. Intervention group included patients that received nebulized and systemic antimicrobials. Patients in the control group received only systemic antimicrobials. Clinical resolution was the primary endpoint. Secondary outcomes included change in fever, inflammatory parameters, and creatinine clearance; length of hospital stay, systemic therapy, and mechanical ventilation; hospital readmission; and mortality. Regression models were performed to estimate the effect of nebulized antibiotics on outcome variables adjusted by potential confounders. A total of 136 patients were included (93 in control group and 43 in intervention group). The intervention group had higher odds of clinical resolution (adjusted odds ratio (OR): 7.1; 95% confidence interval (95% CI): 1.2, 43.3). Nebulized antibiotic therapy was independently associated with reduction in procalcitonin (adjusted OR: 12.4; 95% CI: 1.4, 109.7). There were no significant differences in the rest of the secondary outcomes or in creatinine clearance reduction. Adding nebulized antibiotics for the management of respiratory tract infections has a positive impact on clinical resolution without increasing the risk of renal toxicity.

Future Trends in Nebulized Therapies for Pulmonary Disease

“…A recent retrospective observational study by Leache et al (2020) compared the use of systemic antimicrobials to systemic antimicrobials with adjunctive nebulized antimicrobials for pneumonia or tracheobronchitis. The combination of systemic and nebulized antimicrobials was associated with enhanced clinical resolution without increased renal toxicity [124]. Another recent single-arm clinical trial evaluated clinical outcomes of nebulized (off-label) plus intravenous vancomycin antibiotic in mechanically ventilated patients with MRSA pneumonia.…”