Assessment of Aerosolized Colistin Efficacy for Nosocomial Pneumonia

Obŝaâ Reanimatologiâ

A. M. Golubev¹  A. N. Kuzovlev²  V. V. Moroz²  A. K. Shabanov³ 

[1] N.V. Sklifosovsky Research Institute of Emergency Medicine.;V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology.;V. A. Negovsky Research Institute of General Reanimatology, Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology;

关键词: nosocomial pneumonia;    aerosolized colistin;    aerosolized antibiotics;    nebuliser;   

DOI  :  10.15360/1813-9779-2017-6-60-73

来源: DOAJ

【 摘 要 】

The aim of the study was the assessment of aerosolized colistin (AC) efficacy as adjunctive therapy to systemic antibiotic therapy for nosocomial pneumonia (NP).Materials and methods. This observation study included 90 NP patients under critical care. The primary criterion of therapy efficacy was NP resolution. As the secondary criteria of therapy efficacy, eradication of germs from sputum, the time to patients’ spontaneous breathing, the time in critical care unit, and mortality were evaluated. Patients were split into 2 groups: Gr.1 (n=48) — systemic antibiotics combined with AC; Gr. 2 (n=42) — systemic antibiotics cross over due to sensitivity. The groups were comparable in main characteristics. Aerosolized colistin was dosed 2 mln. U 3 times/day (Xellia Pharmaceuticals ApS, Denmark) in Gr. 1. The regimen of systemic antibiotic therapy was not changed upon AC prescription. Statistical analysis was carried out using Statistica 7.0 (M, σ, Newman—Keuls test; P<0.05).Results. This study has demonstrated efficacy of aerosolized colistin 2 mln. U 3 times/day as adjuvant therapy to systemic antibiotic therapy for NP caused by multidrug-resistant gram-negative germs: the NP resolution rate was 75% (versus 52% in Gr. 2, P=0.0295); eradication of pathogens by therapy day 7 was achieved in 80% in Gr. 1 and 60% Gr. 2 (n=12) (P>0.05); in Gr. 1, spontaneous breathing took place earlier than in Gr. 2 — 7.6±1.6 days in Gr. 1 versus 11.7±3.4 days in Gr. 2 (P=0.0000); in Gr. 1, the critical care unit duration was shorter than in Gr. 2 — 12.0±3.4 days in Gr. 1 versus 16.3±3.4 days in Gr. 2 (P=0.0000). Conclusions. Aerosolized colistin 2 mln. U 3 times a day is an effective adjuvant therapy combined with systemic antibiotic therapy for nosocomial pneumonia caused by multidrug-resistant gram-negative germs. This modified treatment assisted faster pneumonia resolution, earlier spontaneous breathing of patients, and shorter time in the intensive care unit. Addition of aerosolized colistin to systemic antibiotics should be regarded as a possible algorithm of treatment in a case of inefficient first-line antibiotic therapy.

【 授权许可】

Unknown