Efficacy of nebulized colistin-based therapy without concurrent intravenous colistin for ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii

Abstract

Background: Although there have been studies regarding the role of nebulized colistin as adjunctive therapy of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB), a paucity of information on the efficacy of nebulized colistin as monotherapy is available. Methods:We retrospectively reviewed 219 patients with VAP caused by CRAB treated with either intravenous (n=93) or nebulized colistin (n=126), from March 2010 to November 2015. Factors related to clinical failure was assessed using propensity-score-matched analysis.Results: Of 219 patients, 39 patients from each group (n=78) were matched after covariate adjustment using propensity score. There were no significant differences in baseline characteristics as well as the rates of clinical failure between the propensity-score-matched groups [Odds ratio (OR), 0.48; 95% confidence interval (CI), 0.19-1.19; P=0.11], while a significantly lower rate of acute kidney injury (AKI) during colistin therapy (18% vs. 49%, P=0.004) was observed in nebulized colistin group. In addition, multivariable analysis revealed that nebulized colistin did not significantly alter the rate of clinical failure [adjusted odds ratio (aOR), 0.36; 95% CI, 0.12-1.09; P=0.070]. Instead, medical intensive care unit (ICU) admission (aOR, 7.14; 95% CI, 1.60-32.00; P=0.010), and septic shock (aOR, 3.93; 95% CI,; P=0.018) were independent risk factors for clinical failure.Conclusions: Our findings suggest that nebulized colistin-based therapy, even without concurrent administration of intravenous colistin, may be an effective and safe treatment option for VAP caused by CRAB.

Comparison of Septic Shock Due to Multidrug-Resistant Acinetobacter baumannii or Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae in Intensive Care Unit Patients

“…In our population of patients with KPC-Kp septic shock, a carbapenem was the most used antibiotic, mainly in combination with colistin, tigecycline, and/or gentamicin. On the other hand, a carbapenem was used in combination with colistin and/or rifampin for the treatment of MDR-AB infections (27)(28)(29). Despite the observation of only 1 patient with MDR-AB infection due to a colistinresistant strain, a very low proportion of patients were treated with 2 or more antibiotics showing in vitro activity against the isolates of MDR-AB; this probably explains the very high mortality rates observed in this population.…”

Size Distribution of Colistin Delivery by Different Type Nebulizers and Concentrations During Mechanical Ventilation

“…A high dose of inhaled colistin has been proposed to treat VAP, and results have demonstrated its effectiveness with a low acute kidney injury rate [16,17,18]. However, the appropriate dosing and particle size distributions remain unclear, and guidelines for administering inhaled colistin during mechanical ventilation are yet to be established.…”

Cryptococcal infection in HIV-infected patients with CD4+ T-cell counts under 100/μL diagnosed in a high-income country: a multicentre cohort study

“…As a result of the impact of assessment criteria and administration route on observed nephrotoxicity rates, subsequent subgroup analyses of the nephrotoxicity rate were performed in a secondary analysis population that included only studies using internationally recognized assessment criteria (RIFLE, AKIN or KDIGO) and excluded ten studies in which less than 50% patients received systemic polymyxins [19,26,53,66,71,119,143,147,155,243]. The results of these subanalyses are presented here, whereas metaanalyses of the nephrotoxicity rate including all 237 studies regardless of AKI criteria and administration route are presented in Supplementary Figs S1 to S17.…”