Adjunctive aerosolized colistin for multi-drug resistant gram-negative pneumonia in the critically ill: a retrospective study

BMC Anesthesiology

Research Article

Heather M Arnold¹  Neha M Doshi²  Kari L Mount³  Claire V Murphy³  Stanislaw P Stawicki⁴  Charles H Cook⁴  Garrett E Schramm⁵  Heather A Personett⁵  Erin N Frazee⁵ 

[1] Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA;Department of Pharmacy, St. Luke's University Health Network, Bethlehem, PA, USA;Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA;Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA;Pharmacy Services, Mayo Clinic, Rochester, MN, USA;

关键词: Colistin;    Multiple drug resistance;    Pneumonia;    Critical illness;    Pseudomonas;    Acinetobacter;    Aerosolized;   

DOI  :  10.1186/1471-2253-13-45

 received in 2013-04-15, accepted in 2013-11-14,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundThe incidence of multi-drug resistant (MDR) gram-negative (GN) organisms including Pseudomonas and Acinetobacter spp has increased in the last decade, prompting re-evaluation of colistin for the management of these infections. Aerosolized colistin as an adjunct to intravenous therapy is a current option for the management of MDR-GN pneumonia, although data supporting this practice is limited. This study evaluates the efficacy of adjunctive aerosolized colistin in combination with intravenous colistin in critically ill patients with MDR-GN pneumonia.MethodsA retrospective multi-center cohort analysis comparing critically ill patients with MDR-GN pneumonia who received intravenous colistin (IV) alone or in combination with adjunctive aerosolized colistin (IV/AER) with a primary endpoint of clinical cure at the end of colistin therapy. Secondary endpoints included microbiologic cure, duration of mechanical ventilation, length of stay, and hospital mortality. A post-hoc subgroup analysis was performed for patients with high quality cultures used for diagnosis of MDR-GN pneumonia. Dichotomous data were compared using Fisher’s exact test while the student’s t-test or Mann–Whitney U test were used for continuous variables.ResultsNinety-five patients met criteria for evaluation with 51 patients receiving IV and 44 receiving IV/AER. Baseline characteristics were similar between the two groups. Twenty patients (39.2%) receiving IV and 24 (54.5%) receiving IV/AER achieved clinical cure (p = 0.135). There was no difference in microbiologic cure rates between the IV and IV/AER colistin groups (40.7vs. 44.4%, p = 0.805). The IV group demonstrated a trend towards higher pneumonia attributable mortality (70.4 vs. 40%, p = 0.055). In the subgroup analysis of patients with high quality respiratory cultures, there was a significantly lower clinical cure rate for those in the IV group as compared to the IV/AER group (31.3 vs. 57.1%, p = 0.033).ConclusionsAddition of aerosolized colistin to IV colistin may improve clinical cure and mortality for patients with MDR-GN pneumonia. Larger, prospective trials are warranted to confirm the benefit of adjunctive aerosolized colistin in critically ill patients with MDR-GN pneumonia.

【 授权许可】

Unknown   
© Doshi et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.