Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria

Rattanaumpawan, Pinyo; Lorsutthitham, Jintana; Ungprasert, Puangpaka; Angkasekwinai, Nasikarn; Thamlikitkul, Visanu

doi:10.1093/jac/dkq360

Cited by 185 publications

(167 citation statements)

References 6 publications

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“…Concerns over TLV-COL nephrotoxicity may also be less important if COL were to be administered in aerosolized form. Nebulized polymyxins have been increasingly used in the treatment of MDR Gram-negative respiratory tract infections in a number of settings (e.g., ventilatorassociated pneumonia, chronic cystic fibrosis infections), and there is little evidence to suggest they promote renal impairment when delivered via a nebulizer (18).…”

Section: Discussionmentioning

confidence: 99%

In Vitro Activity of Telavancin in Combination with Colistin versus Gram-Negative Bacterial Pathogens

Hornsey

Longshaw

Phee

et al. 2012

Antimicrob Agents Chemother

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ABSTRACTThe treatment of Gram-negative infections is increasingly compromised by the spread of resistance. With few agents currently in development, clinicians are now considering the use of unorthodox combination therapies for multidrug-resistant strains. Here we assessed thein vitroactivity of the novel lipoglycopeptide telavancin (TLV) when combined with colistin (COL) versus 13 Gram-negative type strains and 66 clinical isolates. Marked synergy was observed in either checkerboard (fractional inhibitory concentration index [FICI], <0.5; susceptibility breakpoint index [SBPI], >2) or time-kill assays (>2-log reduction in viable counts compared with starting inocula at 24 h) versus the majority of COL-susceptible enterobacteria,Stenotrophomonas maltophilia, andAcinetobacter baumanniiisolates, but only limited effects were seen againstPseudomonas aeruginosaor strains with COL resistance. Using an Etest/agar dilution method, the activity of TLV was potentiated by relatively low concentrations of COL (0.25 to 0.75 μg/ml), reducing the MIC of TLV from >32 μg/ml to ≤1 μg/ml for 35% of the clinical isolates. This provides further evidence that glycopeptide-polymyxin combinations may be a useful therapeutic option in the treatment of Gram-negative infections.

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Section: Discussionmentioning

confidence: 99%

In Vitro Activity of Telavancin in Combination with Colistin versus Gram-Negative Bacterial Pathogens

Hornsey

Longshaw

Phee

et al. 2012

Antimicrob Agents Chemother

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“…Çalışma-mızda olduğu gibi farklı araştırıcılar da kolistinin en etkili antimikrobiyal ajan olduğunu, ancak karbapenem grubu ajanların aynı derecede etkili olmadığını bildirmişlerdir. Ancak günü-müzde kolistin ile ilgili klinik deneyim oldukça sınırlı olup ciddi yan etkilerinden dolayı klinik kullanımı çok yaygın değildir (25,27,28) . Villalon ve ark.…”

Section: Discussionunclassified

Antimicrobial Resistance of Acinetobacter baumannii Strains Isolated from Clinical Samples in an Education and Research Hospital (2008-2010)

Kurtoğlu¹,

Opuş²,

Kaya³

et al. 2011

ANKEM Derg

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“…In contrast, nebulizing polymyxins has the potential to achieve very high concentrations in the lungs while minimizing systemic exposure and toxicity. Numerous investigators have described favorable outcomes of patients with nonbacteremic Acinetobacter pneumonia who were treated with nebulized polymyxins (252)(253)(254)(255)(256)(257)(258)(259)(260)(261). In one case-control study, use of inhaled colistin increased microbial eradication rate from the airways in ventilated patients compared to systemic therapy (257).…”

Section: Current Treatment Optionsmentioning

confidence: 99%

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

et al. 2017

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SUMMARY Acinetobacter is a complex genus, and historically, there has been confusion about the existence of multiple species. The species commonly cause nosocomial infections, predominantly aspiration pneumonia and catheter-associated bacteremia, but can also cause soft tissue and urinary tract infections. Community-acquired infections by Acinetobacter spp. are increasingly reported. Transmission of Acinetobacter and subsequent disease is facilitated by the organism's environmental tenacity, resistance to desiccation, and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. primarily stem from evasion of rapid clearance by the innate immune system, effectively enabling high bacterial density that triggers lipopolysaccharide (LPS)–Toll-like receptor 4 (TLR4)-mediated sepsis. Capsular polysaccharide is a critical virulence factor that enables immune evasion, while LPS triggers septic shock. However, the primary driver of clinical outcome is antibiotic resistance. Administration of initially effective therapy is key to improving survival, reducing 30-day mortality threefold. Regrettably, due to the high frequency of this organism having an extreme drug resistance (XDR) phenotype, early initiation of effective therapy is a major clinical challenge. Given its high rate of antibiotic resistance and abysmal outcomes (up to 70% mortality rate from infections caused by XDR strains in some case series), new preventative and therapeutic options for Acinetobacter spp. are desperately needed.

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Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria

Abstract: Nebulized CMS as adjunctive therapy of Gram-negative VAP seems to be safe. However, a beneficial effect on clinical outcomes of adjunctive nebulized CMS for therapy of Gram-negative VAP was not ascertained.

Cited by 185 publications

References 6 publications

In Vitro Activity of Telavancin in Combination with Colistin versus Gram-Negative Bacterial Pathogens

In Vitro Activity of Telavancin in Combination with Colistin versus Gram-Negative Bacterial Pathogens

Antimicrobial Resistance of Acinetobacter baumannii Strains Isolated from Clinical Samples in an Education and Research Hospital (2008-2010)

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

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