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Abstract
Background:
Recently, multidrug-resistant (MDR) A. baumannii has been implicated for a significant proportion of nosocominal pneumonia in many intensive care units (ICUs), and its acquisition may increase mortality and the length of stay in the ICU. Aerosolized colistin has been successfully used in patients with cystic fibrosis, but there is a lack of data regarding the use of aerosolized colistin in patients with nosocomial pneumonia.
Methods:
We conducted the present study to assess the effectiveness of aerosolized colistin for the treatment of MDR A. baumannii nosocomial pneumonia. We retrospectively reviewed the medical records of 10 patients who had been hospitalized in the medical ICU and had received aerosolized colistin as a therapy for MDR A. baumannii pneumonia.
Results:
The mean duration of aerosolized colistin therapy was 12.7±2.4 days. Nine (90%) of 10 patients showed a favorable response to the therapy. Follow-up cultures were available for all patients, and the responsible pathogen was completely eradicated. One patient suffered from bronchospasm, which resolved after treatment with nebulized salbutamol.
Conclusion:
Our results corroborate previous reports that aerosolized colistin may be an effective and safe choice for the treatment of nosocomial pneumonia caused by MDR A. baumannii. Larger prospective controlled clinical studies are warranted to validate further the effectiveness and safety of aerosolized colistin therapy. (Tuberc Respir
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Table 1.
Demographic and clinical characteristics of patients
| No. | Sex | Age | Diagnosis at ICU admission | Comorbidities | ICU stay∗ | Hospital stay† | Isolation days‡ | IV antibiotics§ |
|---|---|---|---|---|---|---|---|---|
| 1 | M | 71 | Pneumonia, ARDS | CMV pneumonia | 88 | 136 | 32 | Ganciclovir |
| 2 | F | 50 | Pneumonia, ARDS | Intestinal obstruction, Spontaneous pneumothorax | 69 | 147 | 14 | Tazocin, Aztreonam |
| 3 | M | 71 | Aspiration pneumonia | CBD & colon cancer, Intraabdominal abscess, ARF, Drug induced eosinophilic pneumonia | l 54 | 132 | 6 | Teicoplanin, Imipenem |
| 4 | F | 82 | Pulmonary TB | DM, ARF, acalculous cholecystitis, Renal tubular acidosis, Toxic hepatitis, Sacral sore, Dementia | 129 | 135 | 15 | Antituberculous agents |
| 5 | F | 65 | Pulmonary TB | DM, Toxic hepatitis, Dermatomyositis Sacral sore | s, 71 | 96 | 5 | Antituberculous agents |
| 6 | M | 52 | Pneumonia, ARDS | DM, ARF, Alcoholic liver disease | 63 | 63 | 8 | Teicoplanin, Metronidazole |
| 7 | F | 70 | Pulmonary TB | Interstitial lung disease, DM, CIP | 89 | 102 | 12 | Antituberculous agents |
| 8 | M | 38 | Severe CAP | End stage renal disease, CMV pneumonia, CIP | 74 | 74 | 5 | Ganciclovir, Teicoplanin, Meropenem, Moxifloxacin |
| 9 | M | 78 | Severe CAP | COPD, Liver cirrhosis, CRF, Heart failure, Atrial fibrillation | 21 | 21 | 5 | Teicoplanin, meropenem |
| 10 | M | 41 | Pneumonia, ARDS | Small bowel perforation, Peritonitis, Dieulafoy's ulcer | 26 | 37 | 6 | Teicoplanin, meropenem |
| AVR | 61.8 | 68.4 | 94.3 | 3 10.8 |
ICU: Intensive Care Unit; IV: Intravenous; ARDS: Acute Respiratory Distress Syndrome; CMV: Cytomegalovirus; CBD: Common Bile Duct; ARF: Acute Renal Failure; TB: Tuberculosis; DM: Diabetes Mellitus; CIP: Critical Illness Polyneuropathy; CAP: Community-Acquired Pneumonia; COPD: Chronic Obstructive Pulmonary Disease; CRF: Chronic Renal Failure; AVR: Average.
Table 2.
Clinical outcomes of patients treated with aerosolized colistin
| No. | Sex | Age | Treatment days∗ | Dosage† | Follow-up culture‡ | Outcome | Clinical course | Adverse effect |
|---|---|---|---|---|---|---|---|---|
| 1 | M | 71 | 13 | 75 mg 8 hrs | Pseudomonas aeruginosa | Cure | Discharge | |
| 2 | F | 50 | 7 | 75 mg 8 hrs | Stenotrophomonas maltophilia | Cure | Discharge | |
| 3 | M | 71 | 11 | 75 mg 8 hrs | No bacteria | Cure | Death (Intraabdominal infection) | |
| 4 | F | 82 | 14 | 75 mg 8 hrs | No bacteria | Improvement | Discharge§ | |
| 5 | F | 65 | 14 1 | 150 mg 8 hrs | No bacteria | Cure | Discharge | |
| 6 | M | 52 | 13 1 | 150 mg 8 hrs | Pseudomonas aeruginosa | Improvement | Death (MRSA pneumonia) | |
| 7 | F | 70 | 14 | 75 mg 8 hrs | Stenotrophomonas maltophilia | Improvement | Hospitalization | Bronchospasm |
| 8 | M | 38 | 16 | 75 mg 8 hrs | No bacteria | Improvement | Hospitalization | |
| 9 | M | 78 | 12 | 75 mg 8 hrs | MRSA | Deterioration | Death (MRSA pneumonia) | |
| 10 | M | 41 | 13 | 75 mg 8 hrs | No bacteria | Improvement | Death (Intraabdominal infection) | |
| AVR | 12.7 |
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