Inhalatory and intravenous colistin in treating ventilator-associated pneumonia due to acinetobacter species: Should we combine them?

Abstract

Background / Aim. Acinetobacter is one of the most common causes of nosocomial infections, especially ventilator-associated pneumonia (VAP). Considering the increased presence of multidrug-resistant microorganisms and the lack of novel antibiotics, colistinemerged as the last-resort antibioticfor life threatening nosocomial infections. Intravenous use of antibiotics is accepted as a gold standard for the treatment of pneumonia, but additional administration of inhaled antibiotics in the treatment of VAP has shown to be advantageous in some clinical trials. The aim of this study was to investigate the effect of inhalatory colistin as an adjunct to intravenous colistin on the survival of patients with VAPcaused by Acinetobacter species. Methods. We conducted a retrospective study to evaluate the efficacy of combination of inhalatory and intravenous colistin versus intravenous colistin alone in 69 patients in the ICU with VAP caused by Acinetobacter baumannii. The patients were treatedin the Intensive Care Unit at the Institute for pulmonary diseases of Vojvodinain the period from January 2013 to March 2018. Baseline demographic data, severity of disease, comorbidities, colistinregimen and length of treatmentwere collected.The primary outcome was 28 day mortality. Results. Twenty seven of total 69 patients (39,1%) received combined intravenous and inhalatory colistin. Forty two patient received only intravenous colistin (60,9%).Compared to the combined use of intravenous and inhalatorycolistin, patients receiving intravenous colistinalone had a significantly increased risk of death at 28 days (25,9% vs. 61,9%, OR 4,464, 95% CI 1,539-2,925, p=0,006). Length of colistin use (>7 days) was also associated with survival (OR 0,22, 95% CI 0,080-0,606, p=0,003).After adjusting for baseline severity of illness (APACHE score) and length of colistin treatment, patients receiving only intravenous colistin had greater 28 day mortality compared to patients receiving both intravenous and inhalatory colistin (OR 6,305, 95% CI 1,153, p= 0,004). Conclusion. Our results suggest that adding inhalatory to intravenouscolistin is beneficial in treatment of VAP caused by Acinetobacter species. ApstraktUvod / Cilj. Acinetobacter je jedan od najčećih uzročnika nozokomijalnih infekcija, posebno ventilatorom udružene pneumonije (VAP). Uzimajući u obzir da je sve veći broj multrezistentnih mikroorganizama uz nedostatak novih antibiotika, kolistin je našao svoje mesto u lečenju životno ugrožavajućih nozokomijalnih infekcija. Intravenska primena antibiotika je zlatni standard u lečenju pneumonija, ali dodatak inhalatorne sistemskoj administraciji u lečenju VAP-a pokazala je svoje prednostiu nekim istraživanjima. Cilj naše studije bio je da se ispita efekat inhalatornog kolistina kao dodatka intravenoznom na preživljavanje pacijenata sa VAP-om čiji je uzročnik Acinetobacter. Metode: Sprovedena je retrospektivna studija kako bi se procenila efikasnost kombinacije inhalatornog i CI 1,795-22,153, p= 0,004). Zaključak. Rezultati naše studije ukazuju d...

Efficacy and safety of different polymyxin-containing regimens for the treatment of pneumonia caused by multidrug-resistant gram-negative bacteria: a systematic review and network meta-analysis

“…20–21, Appendix 4, Additional file 2 ). Given the substantial missing data observed in Table 1 of Matijašević et al's study [ 44 ], a sensitivity analysis was conducted with its exclusion. The result was consistent with that of the primary meta-analysis (Supplementary Figs.…”