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J Aerosol Med Pulm Drug Deliv. 2018 Dec;31(6):372-375. doi: 10.1089/jamp.2017.1447. Epub 2018 Mar 27.

Bronchoscopic Improvement of Tracheobronchitis Due to Methicillin-Resistant Staphylococcus aureus After Aerosolized Vancomycin: A Case Series.

Author information

1
1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seongnam, Republic of Korea.
2
2 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Republic of Korea.

Abstract

BACKGROUND:

Ventilator-associated tracheobronchitis (VAT) is an important risk factor for ventilator-associated pneumonia (VAP). The efficacy of aerosolized vancomycin (AV) in treating VAT has not been clearly demonstrated.

METHODS:

Four mechanically ventilated patients with methicillin-resistant Staphylococcus aureus (MRSA) pneumonia were treated with an additional AV. AV (250 mg twice per day) was administered through a vibrating mesh device for 5 days. All patients were receiving intravenous vancomycin and had severe tracheobronchitis, based on bronchoscopic findings before or soon after additional AV treatment.

RESULTS:

After several days of AV treatment, follow-up bronchoscopies showed dramatic improvement of tracheobronchitis. All patients achieved microbiological eradication of MRSA. Finally, two of four patients survived through to hospital discharge.

CONCLUSION:

This case series study suggests a potential role of AV in the treatment of MRSA tracheobronchitis, which were accompanied by VAP. Clinical trial addressing the efficacy of AV in MRSA VAT and/or VAP should be needed.

KEYWORDS:

aerosolized vancomycin; methicillin-resistant ; tracheobronchitis; ventilator-associated pneumonia

PMID:
29583108
DOI:
10.1089/jamp.2017.1447
[Indexed for MEDLINE]

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