Inhaled colistin as adjunctive therapy to intravenous colistin for the treatment of microbiologically documented ventilator-associated pneumonia: a comparative cohort study

Abstract

Ventilator-associated pneumonia (VAP) as a result of multidrug-resistant Gram-negative bacteria has contributed to the revival of the use of intravenous (i.v.) colistin. However, the additional administration of inhaled colistin for VAP is controversial. We performed a retrospective cohort study of patients with microbiologically documented VAP who received i.v. colistin with or without inhaled colistin. Seventy-eight patients with VAP received i.v. plus inhaled colistin, whereas 43 patients received i.v. colistin alone. The mean +/- SD daily dosage of i.v. colistin was 7.0 +/- 2.4 and 6.4 +/- 2.3 million international units (IU), respectively (p 0.13); the average daily dosage of inhaled colistin was 2.1 +/- 0.9 million IU. The outcome of infection was cure for 62/78 (79.5%) patients who received i.v. plus inhaled colistin vs. 26/43 (60.5%) patients who received i.v. colistin alone (p 0.025); all-cause in-hospital mortality was 31/78 (39.7%) vs. 19/43 (44.2%), respectively (p 0.63); all-cause intensive care unit (ICU) mortality was 28/78 (35.9%) vs. 17/43 (39.5%), respectively (p 0.92). The use of inhaled colistin was independently associated with the cure of VAP in a multivariable analysis (OR 2.53, 95% CI 1.11-5.76). Independent predictors of mortality were a higher APACHE II score (OR 1.12, 95% CI 1.04-1.20), presence of malignancy (OR 4.11, 95% CI 1.18-14.23) and lower daily dosage of i.v. colistin (OR 0.81, 95% CI 0.68-0.96). The outcome of VAP was better in patients who received inhaled colistin with i.v. colistin than those who received i.v. colistin alone. There was no difference in all-cause in-hospital and ICU mortality between the two groups. Randomized controlled trials are needed to evaluate further the role of inhaled colistin in VAP.

Efficacy and Safety Profile Comparison of Colistin and Tigecycline on the Extensively Drug Resistant <i>Acinetobacter baumannii</i>

“…20) Inhaled colistin can be considered based on the better result from colistin inhalation treatment in patients with ventilator associated pneumonia. 21) Therefore, relatively low treatment success rate (48.7%) in our study may be related with low distribution of colistin to lung tissue and relatively many pneumonia patients.…”

Efficacy and Safety of Aerosolized Colistin in the Treatment of Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis

“…총 9개의 문헌 (randomized controlled trial 1개 27) , cohort 5개 [22][23][24][25][26] , case-control 3개 24,28,30) ) 중 8개 문헌에 대해서는 Newcastle-Ottawa Quality Assessment Scale을 1개의 문헌에 대해서는 Cochrane risk-of-bias tool을 사용하여 quality를 평 가하였고 그 결과는 Table 1에 제시하였다. 각 문헌의 quality assessment 결과 한 연구 참고문헌…”

Inhaled Colistin Use for Multi-Drug Resistant Gram-Negative Pneumonia in an Immunocompromised Patient: Case Report

“…[15][16][17][18][19] There are few observational, retrospective, uncontrolled small case series, including patients with malignancies, about use of combination of inhaled and intravenous colistin for management of hospital acquired pneumonia (HAP) caused by MDR Pseudomonas aeruginosa. 12,14,19,20 Herein, we present a case with lymphoma developed neutropenia and subsequently HAP caused by MDR Pseudomonas aeruginosa, and treated successfully with combined colistin therapy.…”