Microbiological Progress in Patients with Bronchial Infection with <b><i>Pseudomonas aeruginosa</i></b> Treated with Nebulised Colistin

Abstract

Background: Inhaled antibiotics allow the delivery of higher drug concentrations at the site of infection without the systemic adverse effects observed with the use of parenteral or oral antibiotics. These antibiotics have shown to decrease the number of exacerbations, reduce bacterial load or improve pulmonary function in several chronic respiratory conditions. Objectives: The aim of this study was to describe changes in the bacteriology of sputum in patients with chronic bronchial infection with Pseudomonas aeruginosa treated with nebulised colistin. Material and Methods: All patients with chronical infection with P. aeruginosa treated with nebulised colistin attending a day care unit during a 5-year (January 2010 to December 2014) period were included. Repeated-measures t tests were used to assess whether the introduction of colistin was associated with changes in the number of exacerbations or the length of the hospitalisations. Results: Treatment with colistin was associated with a decrease in the number of ambulatory exacerbations (1.87–1.1, p = 0.007), of hospital exacerbations (1.3–0.7, p = 0.010) and of length of stay (15.7–8.6 days, p = 0.005). There was no linear trend in the proportion of isolate Enterobacteriaceae, gram-positive cocci, Haemophilus influenzae or fungi. Isolation of Enterobacteriaceae within 1 year after the beginning of the treatment with nebulised colistin was associated with an increase in the number of ambulatory exacerbations (incidence rate ratio 1.99, 95% CI 1.05–3.79). Conclusions: Nebulised colistin was effective in the treatment of chronic infection with P. aeruginosa, and no significant changes in the microbiological evolution were observed. Isolation of Enterobacteriaceae within 1 year after the beginning of the treatment with nebulised colistin was associated with an increase in the number of exacerbations.

Clinical Course of Children with Chronic Suppurative Lung Disease or Bronchiectasis Infected with Pseudomonas aeruginosa

“…Although many inhaled antibiotics have been developed and are currently in use, only colistin was available for our patients since it is the only inhaled antibiotic that is compensated by the national health insurance system for non-CF patients. Long-term treatment with inhaled antibiotics reduces the number of exacerbations, decreases bacterial load, and improves pulmonary function in several chronic endobronchial infections [ 20 , 22 , 23 , 24 ]. Our data are in general agreement with the above results as they demonstrated that the prolonged use of inhaled colistin increased the rate of microbiological clearance.…”

Clinical course of children with chronic suppurative lung disease or bronchiectasis infected with Pseudomonas aeruginosa

“…Although many inhaled antibiotics have been developed and are currently in use, only colistin was available for our patients since it is the only inhaled antibiotic that is compensated by the national health insurance system for non-CF patients. Long-term treatment with inhaled antibiotics reduces the number of exacerbations, decreases bacterial load, and improves pulmonary function in several chronic endobronchial infections 19,[21][22][23] . Our data are in general agreement with the above results as they demonstrated that the prolonged use of inhaled colistin increased the rate of remission.…”

Inhaled Colistimethate Sodium in the Management of Patients with Bronchiectasis Infected by Pseudomonas aeruginosa: A Narrative Review of Current Evidence

“…These same authors subsequently published an extension of this study in a larger sample of 62 patients, with the aim of describing changes in the bacteriology of sputum in relation to treatment with nebulized colistin. 62 The results showed that there was no linear trend in the proportion of isolate Enterobacteriaceae, Gram-positive cocci, Haemophilus influenzae , or fungi. Isolation of Enterobacteriaceae within a year of the initial administration of nebulized colistin was associated with more ambulatory exacerbations.…”