Re-emerging of colistin for treatment of nosocomial pneumonia due to gram negative multi-drug resistant pathogens in critically ill patients

Amin, Mohamed; Rashad, Alaa; Fouad, Assem; Azeem, Amal Abdel

doi:10.1016/j.ejcdt.2013.05.012

Cited by 13 publications

(20 citation statements)

References 25 publications

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“…1 ). Those 23 articles consist of four RCTs [ 44 – 47 ], three prospective observational studies [ 48 – 50 ], and sixteen retrospective studies [ 51 – 66 ]. A PRISMA extension checklist for reporting systematic reviews comparing multiple treatments involving NMA is shown in Additional file 1 : Table S1.…”

Section: Resultsmentioning

confidence: 99%

Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis

Jung

Lee

et al. 2017

Crit Care

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BackgroundAn optimal therapy for the treatment of pneumonia caused by drug-resistant Acinetobacter baumannii remains unclear. This study aims to compare various antimicrobial strategies and to determine the most effective therapy for pneumonia using a network meta-analysis.MethodsSystematic search and quality assessment were performed to select eligible studies reporting one of the following outcomes: all-cause mortality, clinical cure, and microbiological eradication. The primary outcome was all-cause mortality. A network meta-analysis was conducted with a Bayesian approach. Antimicrobial treatments were ranked based on surface under the cumulative ranking curve (SUCRA) value along with estimated median outcome rate and corresponding 95% credible intervals (CrIs). Two treatments were considered significantly different if a posterior probability of superiority (P) was greater than 97.5%.ResultsTwenty-three studies evaluating 15 antimicrobial treatments were included. Intravenous colistin monotherapy (IV COL) was selected as a common comparator, serving as a bridge for developing the network. Five treatments ranked higher than IV COL (SUCRA, 57.1%; median all-cause mortality 0.45, 95% CrI 0.41–0.48) for reducing all-cause mortality: sulbactam monotherapy (SUL, 100.0%; 0.18, 0.04–0.42), high-dose SUL (HD SUL, 85.7%; 0.31, 0.07–0.71), fosfomycin plus IV COL (FOS + IV COL, 78.6%; 0.34, 0.19–0.54), inhaled COL plus IV COL (IH COL + IV COL, 71.4%; 0.39, 0.32–0.46), and high-dose tigecycline (HD TIG, 71.4%; 0.39, 0.16–0.67). Those five treatments also ranked higher than IV COL (SUCRA, 45.5%) for improving clinical cure (72.7%, 72.7%, 63.6%, 81.8%, and 90.9%, respectively). Among the five treatments, SUL (P = 98.1%) and IH COL + IV COL (P = 99.9%) were significantly superior to IV COL for patient survival and clinical cure, respectively. In terms of microbiological eradication, FOS + IV COL (P = 99.8%) and SUL (P = 98.9%) were significantly superior to IV COL.ConclusionsThis Bayesian network meta-analysis demonstrated the comparative effectiveness of fifteen antimicrobial treatments for drug-resistant A. baumannii pneumonia in critically ill patients. For survival benefit, SUL appears to be the best treatment followed by HD SUL, FOS + IV COL, IH COL + IV COL, HD TIG, and IV COL therapy, in numerical order.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1916-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis

Jung

Lee

et al. 2017

Crit Care

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“…Treatment continued according to clinical response with close monitoring for the possibilities of nephrotoxicity and neurotoxicity; dosages were adjusted for patients with renal impairment. Imipenem 500 mg iv four times per day was used in combination with colistin in 28/64 of VAP cases 10,22. Effective antibiotic therapy was determined by complete clinical cure, ie improvement of all symptoms, signs and laboratory values related to the VAP infection, while failed treatment was defined as persistence of symptoms and signs of VAP despite antimicrobial treatment 23.…”

Section: Methodsmentioning

confidence: 99%

<p>New Delhi metallo-β-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>

Elbrolosy

Labeeb

Hassan

2019

IDR

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Background Acinetobacter spp. are increasingly important microbes involved in late-onset ventilator-associated pneumonia (VAP). Purpose The aims of this study were to determine the prevalence of New Delhi metallo-β-lactamase (MβL) ( bla NDM-1)-producing Acinetobacter spp. among late-onset VAP patients in different intensive care units (ICUs) of Menoufia and Kasr Al Ainy University Hospitals, to investigate the possible risk factors contributing to the acquisition of bla NDM-1-producing Acinetobacter infection, and to correlate between antimicrobial resistance pattern and therapeutic efficacy as well as clinical outcomes of these patients. Materials and methods Sixty-four Acinetobacter isolates were collected from mechanically ventilated patients with suspected late-onset VAP and subjected to antimicrobial susceptibility testing. The modified Hodge test (MHT) and combined disk tests (CDT) were applied for bla NDM-1 MβL detection. Acinetobacter isolates with phenotypically confirmed MβLs production were subjected to a PCR assay to verify the presence of bla NDM-1 gene. The most obvious risk factors for acquisition of carbapenem resistance in VAP patients and treatment outcomes were also analyzed. Results Out of 64 Acinetobacter isolates, 42 (65.6%) proved to be bla NDM-1 positive. The sensitivity and specificity of MHT were 52.38% and 41.67%, while for CDT they were 92.86% and 83.33%, respectively. Acinetobacter isolates showed high susceptibility to colistin (85.7%). The clinical response was better among VAP patients who received combined carbapenem plus colistin therapy than those who received colistin alone. Relapse of infection was detected in 12.5% (8/64) of VAP cases. The reported mortality reached 46.8% (30/64) of which 27 (64.3%) were infected with bla NDM-1-positive isolates. Prolonged duration of mechanical ventilation, longer hospital and ICU stays, and prior exposure to antibiotic therapy were by far the most important factors predisposing to carbapenem resistance among VAP patients. Conclusion A worldwide spread of Acinetobacter spp. expressing carbapenemases represents a significant threat to the medical community. The current study addressed the high prevalence of bla NDM-1-producing Acinetobacter isolates among late-onset VAP patients.

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“…Between 2005 and 2019, 25 articles reporting the use of nebulized CMS as a treatment of MDR VAP and VAT were published [15,. Nineteen were retrospective studies [15,[18][19][20][21][23][24][25][26][27][29][30][31][32][33]35,36,38,39], four prospective observational studies [28,34,40,41] and two randomized control trials (RCTs) [22,37]. Twelve studies concerned the administration of nebulized CMS alone for treating VAP and VAT [15,18,19,22,[26][27][28][32][33][34]36,41].…”

Section: Treatment Of Mdr Gnb Ventilator-associated Pneumoniamentioning

confidence: 99%

“…Twelve studies concerned the administration of nebulized CMS alone for treating VAP and VAT [15,18,19,22,[26][27][28][32][33][34]36,41]. Thirteen studies compared the administration of nebulized CMS alone to the combination of intravenous and nebulized CMS for treating VAP [20,21,[23][24][25][29][30][31]35,[37][38][39][40]. Between 2005 and 2016, either low-1.2 to 4 million IU/day- [15,18,20,21,23,24,28,31,32,34] or high-4 million IU/day- [19,22,25,27,29,33,35,36] CMS doses were nebulized.…”

Section: Treatment Of Mdr Gnb Ventilator-associated Pneumoniamentioning

confidence: 99%

Nebulized Colistin in Ventilator-Associated Pneumonia and Tracheobronchitis: Historical Background, Pharmacokinetics and Perspectives

et al. 2021

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Clinical evidence suggests that nebulized colistimethate sodium (CMS) has benefits for treating lower respiratory tract infections caused by multidrug-resistant Gram-negative bacteria (GNB). Colistin is positively charged, while CMS is negatively charged, and both have a high molecular mass and are hydrophilic. These physico-chemical characteristics impair crossing of the alveolo-capillary membrane but enable the disruption of the bacterial wall of GNB and the aggregation of the circulating lipopolysaccharide. Intravenous CMS is rapidly cleared by glomerular filtration and tubular excretion, and 20–25% is spontaneously hydrolyzed to colistin. Urine colistin is substantially reabsorbed by tubular cells and eliminated by biliary excretion. Colistin is a concentration-dependent antibiotic with post-antibiotic and inoculum effects. As CMS conversion to colistin is slower than its renal clearance, intravenous administration can lead to low plasma and lung colistin concentrations that risk treatment failure. Following nebulization of high doses, colistin (200,000 international units/24h) lung tissue concentrations are > five times minimum inhibitory concentration (MIC) of GNB in regions with multiple foci of bronchopneumonia and in the range of MIC breakpoints in regions with confluent pneumonia. Future research should include: (1) experimental studies using lung microdialysis to assess the PK/PD in the interstitial fluid of the lung following nebulization of high doses of colistin; (2) superiority multicenter randomized controlled trials comparing nebulized and intravenous CMS in patients with pandrug-resistant GNB ventilator-associated pneumonia and ventilator-associated tracheobronchitis; (3) non-inferiority multicenter randomized controlled trials comparing nebulized CMS to intravenous new cephalosporines/ß-lactamase inhibitors in patients with extensive drug-resistant GNB ventilator-associated pneumonia and ventilator-associated tracheobronchitis.

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Re-emerging of colistin for treatment of nosocomial pneumonia due to gram negative multi-drug resistant pathogens in critically ill patients

Cited by 13 publications

References 25 publications

Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis

Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis

<p>New Delhi metallo-β-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>

Nebulized Colistin in Ventilator-Associated Pneumonia and Tracheobronchitis: Historical Background, Pharmacokinetics and Perspectives

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Re-emerging of colistin for treatment of nosocomial pneumonia due to gram negative multi-drug resistant pathogens in critically ill patients

Cited by 13 publications

References 25 publications

Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis

Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis

<p>New Delhi metallo-&beta;-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>

Nebulized Colistin in Ventilator-Associated Pneumonia and Tracheobronchitis: Historical Background, Pharmacokinetics and Perspectives

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<p>New Delhi metallo-β-lactamase-producing <em>Acinetobacter</em> isolates among late-onset VAP patients: multidrug-resistant pathogen and poor outcome</p>