Original Research: Critical Care |

Effect of Aerosolized Colistin as Adjunctive Treatment on the Outcomes of Microbiologically Documented Ventilator-Associated Pneumonia Caused by Colistin-Only Susceptible Gram-Negative BacteriaAerosolized Colistin Adjunctive Treatment

Mario Tumbarello, MD; Gennaro De Pascale, MD; Enrico Maria Trecarichi, MD, PhD; Salvatore De Martino, MD; Giuseppe Bello, MD; Riccardo Maviglia, MD; Teresa Spanu, MD; Massimo Antonelli, MD
Author and Funding Information

From the Institute of Infectious Diseases (Drs Tumbarello and Trecarichi), the Department of Intensive Care and Anesthesiology (Drs De Pascale, De Martino, Bello, and Maviglia and Prof Antonelli), and the Institute of Microbiology (Prof Spanu), Università Cattolica del Sacro Cuore, Rome, Italy.

Correspondence to: Mario Tumbarello, MD, Istituto Malattie Infettive, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Roma, Italy; e-mail: tumbarello@rm.unicatt.it

Funding/Support: This study was partially supported by a grant from the Università Cattolica del Sacro Cuore, Linea D1 2012.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(6):1768-1775. doi:10.1378/chest.13-1018
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Background:  The increasing frequency of ventilator-associated pneumonia (VAP) caused by colistin-only susceptible (COS) gram-negative bacteria (GNB) is of great concern. Adjunctive aerosolized (AS) colistin can reportedly increase alveolar levels of the drug without increasing systemic toxicity. Good clinical results have been obtained in patients with cystic fibrosis, but conflicting data have been reported in patients with VAP.

Methods:  We conducted a retrospective, 1:1 matched case-control study to evaluate the efficacy and safety of AS plus IV colistin vs IV colistin alone in 208 patients in the ICU with VAP caused by COS Acinetobacter baumannii, Pseudomonas aeruginosa, or Klebsiella pneumoniae.

Results:  Compared with the IV colistin cohort, the AS-IV colistin cohort had a higher clinical cure rate (69.2% vs 54.8%, P = .03) and required fewer days of mechanical ventilation after VAP onset (8 days vs 12 days, P = .001). In the 166 patients with posttreatment cultures, eradication of the causative organism was also more common in the AS-IV colistin group (63.4% vs 50%, P = .08). No between-cohort differences were observed in all-cause ICU mortality, length of ICU stay after VAP onset, or rates of acute kidney injury (AKI) during colistin therapy. Independent predictors of clinical cure were trauma-related ICU admission (P = .01) and combined AS-IV colistin therapy (P = .009). Higher mean Simplified Acute Physiology Score II (P = .002) and Sequential Organ Failure Assessment (P = .05) scores, septic shock (P < .001), and AKI onset during colistin treatment (P = .04) were independently associated with clinical failure.

Conclusions:  Our results suggest that AS colistin might be a beneficial adjunct to IV colistin in the management of VAP caused by COS GNB.

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