Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis

Zhang, Xiaoyu; Cui, Xiumin; Jiang, Mengke; Huang, Shanshan; Yang, Mao

doi:10.1016/j.jcrc.2023.154315

Cited by 13 publications

(10 citation statements)

References 45 publications

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“…The results of our study align with previous evidence in the field [ 7 , 21 ]. However, a notable difference between our study and previous systematic reviews is the inclusion of the studies conducted by Angermain and Hallal [ 14 , 16 ].…”

Section: Discussionsupporting

confidence: 93%

“…Colistin and tobramycin are the most commonly prescribed nebulized antibiotics [ 6 ]. Previous systematic reviews have examined the efficacy of adjunctive inhaled antibiotic therapy for VAP treatment [ 7 – 10 ]. However, contrary to more recent studies, these systematic reviews did not find any advantages in utilizing adjunctive inhaled antibiotics, including in terms of clinical cure rates.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of adjunctive inhaled colistin and tobramycin for ventilator-associated pneumonia: systematic review and meta-analysis

Buendía,

Guerrero Patiño,

Zuluaga Salazar

2024

BMC Pulm Med

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Introduction Ventilator-associated pneumonia (VAP) presents a significant challenge in intensive care units (ICUs). Nebulized antibiotics, particularly colistin and tobramycin, are commonly prescribed for VAP patients. However, the appropriateness of using inhaled antibiotics for VAP remains a subject of debate among experts. This study aims to provide updated insights on the efficacy of adjunctive inhaled colistin and tobramycin through a comprehensive systematic review and meta-analysis. Methods A thorough search was conducted in MEDLINE, EMBASE, LILACS, COCHRANE Central, and clinical trials databases (www.clinicaltrials.gov) from inception to June 2023. Randomized controlled trials (RCTs) meeting specific inclusion criteria were selected for analysis. These criteria included mechanically ventilated patients diagnosed with VAP, intervention with inhaled Colistin and Tobramycin compared to intravenous antibiotics, and reported outcomes such as clinical cure, microbiological eradication, mortality, or adverse events. Results The initial search yielded 106 records, from which only seven RCTs fulfilled the predefined inclusion criteria. The meta-analysis revealed a higher likelihood of achieving both clinical and microbiological cure in the groups receiving tobramycin or colistin compared to the control group. The relative risk (RR) for clinical cure was 1.23 (95% CI: 1.04, 1.45), and for microbiological cure, it was 1.64 (95% CI: 1.31, 2.06). However, there were no significant differences in mortality or the probability of adverse events between the groups. Conclusion Adjunctive inhaled tobramycin or colistin may have a positive impact on the clinical and microbiological cure rates of VAP. However, the overall quality of evidence is low, indicating a high level of uncertainty. These findings underscore the need for further rigorous and well-designed studies to enhance the quality of evidence and provide more robust guidance for clinical decision-making in the management of VAP.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Efficacy of adjunctive inhaled colistin and tobramycin for ventilator-associated pneumonia: systematic review and meta-analysis

Buendía,

Guerrero Patiño,

Zuluaga Salazar

2024

BMC Pulm Med

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“…Non parenteral administration of colistin has also been reported. Nebulised colistin has been used mainly as an adjunctive to intravenous treatment and rarely as a monotherapy without providing any significant benefit in the majority of studies, although data are scarce and mostly older than the timeframe we elected to evaluate [ 74 , 75 ]. While a potential drawback is bronchospasm in some patients, the medication has also been used in children in its aerosolised form, without any major safety concern in patients with and without cystic fibrosis.…”

Section: Resultsmentioning

confidence: 99%

Current Therapeutic Approaches for Multidrug-Resistant and Extensively Drug-Resistant Acinetobacter baumannii Infections

Rafailidis,

Panagopoulos,

Koutserimpas

et al. 2024

Antibiotics

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The treatment of Acinetobacter baumannii infections remains a challenge for physicians worldwide in the 21st century. The bacterium possesses a multitude of mechanisms to escape the human immune system. The consequences of A. baumannii infections on morbidity and mortality, as well on financial resources, remain dire. Furthermore, A. baumannii superinfections have also occurred during the COVID-19 pandemic. While prevention is important, the antibiotic armamentarium remains the most essential factor for the treatment of these infections. The main problem is the notorious resistance profile (including resistance to carbapenems and colistin) that this bacterium exhibits. While newer beta lactam/beta-lactamase inhibitors have entered clinical practice, with excellent results against various infections due to Enterobacteriaceae, their contribution against A. baumannii infections is almost absent. Hence, we have to resort to at least one of the following, sulbactam, polymyxins E or B, tigecycline or aminoglycosides, against multidrug-resistant (MDR) and extensively drug-resistant (XDR) A. baumannii infections. Furthermore, the notable addition of cefiderocol in the fight against A. baumannii infections represents a useful addition. We present herein the existing information from the last decade regarding therapeutic advances against MDR/XDR A. baumannii infections.

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“…Regarding the administration of nebulised antibiotics for pulmonary ABI, the paucity of information, the lack of effect on mortality, the complexity and cost of antimicrobial nebulisation, and the increase in bronchospasm episodes do not suggest that the use of nebulised antibiotics in patients with pneumonia caused by Gram-negative bacteria, including MDR cases, should be recommended at this time [224–227,228 ▪ ,229 ▪ ,230].…”

Section: What Are the Alternative Treatments For Acinetobacter Bauman...mentioning

confidence: 99%

How to treat severe Acinetobacter baumannii infections

Bouza,

Muñoz,

Burillo

2023

Current Opinion in Infectious Diseases

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Purpose of review To update the management of severe Acinetobacter baumannii infections (ABI), particularly those caused by multi-resistant isolates. Recent findings The in vitro activity of the various antimicrobial agents potentially helpful in treating ABI is highly variable and has progressively decreased for many of them, limiting current therapeutic options. The combination of more than one drug is still advisable in most circumstances. Ideally, two active first-line drugs should be used. Alternatively, a first-line and a second-line drug and, if this is not possible, two or more second-line drugs in combination. The emergence of new agents such as Cefiderocol, the combination of Sulbactam and Durlobactam, and the new Tetracyclines offer therapeutic options that need to be supported by clinical evidence. Summary The apparent limitations in treating infections caused by this bacterium, the rapid development of resistance, and the serious underlying situation in most cases invite the search for alternatives to antibiotic treatment, the most promising of which seems to be bacteriophage therapy.

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Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis

Cited by 13 publications

References 45 publications

Efficacy of adjunctive inhaled colistin and tobramycin for ventilator-associated pneumonia: systematic review and meta-analysis

Efficacy of adjunctive inhaled colistin and tobramycin for ventilator-associated pneumonia: systematic review and meta-analysis

Current Therapeutic Approaches for Multidrug-Resistant and Extensively Drug-Resistant Acinetobacter baumannii Infections

How to treat severe Acinetobacter baumannii infections

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