Efficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii

Jang, Ji Young; Kwon, Ha Yan; Choi, Eun Hee; Lee, Won Yeon; Shim, Hongjin; Bae, Keum Seok

doi:10.1016/j.jcrc.2017.04.004

Cited by 34 publications

(24 citation statements)

References 31 publications

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“…*Trimethoprim-sulfamethoxazole was used in non-polymyxins group focus of infection helps. This was in agreement with the previous studies reporting the efficacy of IV polymyxins combined with inhaled or intracranial polymyxins, which was significantly superior to IV polymyxins alone for treating CRAB induced pneumonia and meningitis [32][33][34]. Limited penetration into alveoli and limited ability to cross the blood-brain barrier of polymyxins can partly explain our findings [35,36].…”

Section: Discussionsupporting

confidence: 93%

Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis

et al. 2020

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Background: The prevalence of infections due to carbapenem-resistant Acinetobacter baumannii (CRAB) is on the rise worldwide. Polymyxins are considered as last-resort drugs for CRAB infections, but there is still controversy regarding the efficacy and safety of polymyxins based therapies in CRAB infections. The present systematic review was designed to compare the efficacy and safety of polymyxins based therapies versus non-polymyxins based therapies in CRAB infections. Methods:We performed a systematic literature search in PubMed, Embase, CINAHL, Cochrane Library, and clinicaltrials. gov to identify eligible studies reporting the clinical outcomes of patients with CRAB infections. The meta-analysis employed a random-effects model to estimate the odds ratio (OR) and standardized mean difference (SMD) with 95% confidence interval (CI). The primary outcome was 1-month mortality for any cause. We also examined clinical response, microbiological response, length of stay in hospital, and adverse events.Results: Eleven eligible studies were analyzed (1052 patients in total), including 2 randomized clinical trials. Serious risk of bias was found in 8 out of the 11 studies. There was no statistically significant difference between polymyxins based therapies and non-polymyxins based therapies in 1-month mortality for any cause (OR, 0.95; 95% CI, 0.59 to 1.53), microbiological response (OR, 3.83; 95% CI, 0.90 to 16.29) and length of stay in hospital (SMD, 0.24; 95% CI, − 0.08 to 0.56). The pooled OR of clinical response indicated a significant difference in favor of polymyxin based therapies (OR, 1.99; 95% CI, 1.31 to 3.03). The pooled OR of adverse events showed that non-polymyxins based therapies were associated with fewer adverse events (OR, 4.32; 95% CI, 1.39 to 13.48).

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Section: Discussionsupporting

confidence: 93%

Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis

et al. 2020

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“…More recent studies including a recent meta‐analysis of inhaled CMS and a retrospective review comparing 95 critically ill surgical patients who were diagnosed with A. baumannii VAP support the notion that nebulized CMS may have less nephrotoxicity and provide similar clinical results, compared to IV CMS . Interestingly, in a systemic review the combination of inhaled CMS + IV CMS was significantly superior to IV CMS for patient survival and clinical cure for the treatment of resistant A. baumannii pneumonia in critically ill patients . These recommendations place high value on pharmacologic considerations.…”

Section: Clinical Questions and Recommendationsmentioning

confidence: 99%

“…141 Interestingly, in a systemic review the combination of inhaled CMS + IV CMS was significantly superior to IV CMS for patient survival and clinical cure for the treatment of resistant A. baumannii pneumonia in critically ill patients. 142,143 These recommendations place high value on pharmacologic considerations.…”

Section: Should Monotherapy or Combination Therapy For Polymyximentioning

confidence: 99%

International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)

et al. 2019

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The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram‐negative infections. Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B. We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti‐Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin‐based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure. The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use.

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“…Jang et al, 22 retrospectively compared 95 critically ill surgical patients who were diagnosed with VAP (due to A. baumannii) and received high dose nebulized or IV colistin (4.5 million Iu every 8 hours). This study showed that frequent use of nebulized colistin was effective for preventing nephro-toxicity and also had non-inferior clinical and microbiological outcomes compared to IV group.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii

Cited by 34 publications

References 31 publications

Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis

Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis

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