PURPOSE: To sterilize colonized airway by multirresistent Acinetobacter baumanii (MAB) with aerosol's colimicine (AE) and to prevent mechanical ventilation associated pneumonia (MVAP).
METHODS: Inclusion criteria: patients admitted in critical care unit (ICU) with mechanical ventilation (MV), ABM isolation in bronquial secretions, and blood species culture negatives. Exclusion criteria: 1, MVAP: patients with a new infiltrate in thorax radiography and one of the following: temperature >38°C or hypothermia; leucocytes >12.000/μL or <4000/μL; and purulent bronchial secretions; 2. a new organ disfuction whose origin was septic; 3, colimicine contraindication. Drug administration: 1, Collection of take bronchial secretions and blood specimen; 2. bronchodilator administrations if they were necessaries before AC administration; 3. colimicine administration (sodium colistimetate) 1 million UI in sterile water down 5cc/8h; for patients under MV we used Evita-4 and Evita-2 (Dräger) ventilators; if the patient was breathing spontaneously through a tracheostomy we applied AC with a casserole connectted to oxygen (8lpm); 4, intravenous colimicine (IVC) doses were <60kg=50.000 UI/kg/24h, >60 kg=1-2 millions/8h; 5. we took away one bronchial specimen/week and when physician considered necessary; 8, when tracheostomy or orotracheal tube were removed, we stopped drug administration.
RESULTS: 27 patients were enrolledd. We distinguised five groups: control group (n=11) nobody received colimicine; Group 1: patients received AC and/or IVC (n=16); Group 2: patients received only AC (n=8); Group 3: patients received only IVC (n=5); and Group 4: patients received AC+IVC (n=3). We didn’t found relation between AC administration and VMAP (Chi2 0.052;p=0.678), neither with IVC (Chi2 0.374;p=0,547) or AC+IVC administration (Chi2 1,131;p=0,396). Mortality was: control group, 36.4%; group 1, 37,5% (Chi2 0.004;p=0.952), group 2, 25% (Chi2 0.277;p=0,494); group 3, 40% (Chi2 0,019;p=0,654) and group 4, 66,7% (Chi2 0,884;p=0,385). No difference with control group was detected.
CONCLUSION: Colimicine administration hasn’t influence over NAVM prevention and associated mortality in patients with airway colonization by MBA.
CLINICAL IMPLICATIONS: AC administration could decrease NAVM incidence. Larger and randomized clinical trial are necessaries to clear the role of AC in airway colonization by MBA.
DISCLOSURE: Jorge Sinclair-Avila, No Financial Disclosure Information; No Product/Research Disclosure Information