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J Crit Care. 2017 Aug;40:251-256. doi: 10.1016/j.jcrc.2017.04.004. Epub 2017 Apr 7.

Efficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii.

Author information

1
Trauma Center, Department of Surgery, Yonsei University Wonju College of Medicine, Republic of Korea.
2
Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Republic of Korea.
3
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Republic of Korea.
4
Trauma Center, Department of Surgery, Yonsei University Wonju College of Medicine, Republic of Korea. Electronic address: simong3@yonsei.ac.kr.

Abstract

PURPOSE:

Few studies have compared nebulized and intravenous (IV) colistin for multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa pneumonia. This study compared the nephrotoxicity and clinical outcomes for these two delivery routes.

METHODS:

This study retrospectively compared 95 critically ill surgical patients who were diagnosed with Acinetobacter baumannii ventilator associated pneumonia and received colistin between March 2013 and January 2016.

RESULTS:

The most common diagnoses were brain hemorrhage (27.4%), traumatic brain injury (20%), traumatic thoracic injury (15.8%), and secondary peritonitis (11.6%). Compared to the IV group, the nebulizer group was significantly older (60.0 vs. 67.5years, p=0.010), had higher APACHE II scores (16.3 vs. 19.9, p=0.001), and more frequently had diabetes mellitus (6.8% vs. 21.6%, p=0.043). Nephrotoxicity was more common in the IV group (60.5% vs. 15.7%, p<0.0001). Both groups had similar microbiological and clinical outcomes (p=0.921 and p=0.719, respectively). Patients with nephrotoxicity exhibited prolonged IV or nebulized colistin treatment and more frequent combination with vancomycin. Nephrotoxicity was independently associated with IV delivery (odds ratio: 8.48, 95% confidence interval: 2.95-24.39, p<0.0001).

CONCLUSIONS:

Nebulized colistin may have less nephrotoxicity and provide similar clinical results, compared to IV colistin.

KEYWORDS:

Acinetobacter baumannii; Colistin; Inhalation; Nebulizer; Ventilator-associated pneumonia

PMID:
28458172
DOI:
10.1016/j.jcrc.2017.04.004
[Indexed for MEDLINE]

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