PURPOSE: Multi-drug resistant(MDR) gram negative bacteria is a common cause of nosocomial pneumonia. Intravenous Colistin has a antibacterial effect againt MDR gram negative aerobic pathogens, however it cause frequent renal and neurological adverse effects. We designed the present study to assess the safety and the effectiveness of aerosolized colistin as an adjunct to intravenous antimicrobial therapy for treatment of Grma-negative nosocomial pneumonia.
METHODS: We retrospectively reviewed the medical records of patients hospitalized in a 800-bed tertiary care hospital during the period from December 2006 to April 2007, and who received nebulized colistin as adjunctive therapy for MDR pneumonia.
RESULTS: 20 patients were enrolled. All patients had been admitted to the MICU, with mean APACHE II scores on the day of ICU admission of 18. The responsible pathogens were Acinetobacter baumannii (in 20 patients) and Pseudomonas aeruginosa (in 2 out of 20 patients, with A baumannii)strains. The isolated pathogens were resistant to all tested antibiotics, including carbapenem(except colistin). The daily dose of nebulized colitin was 225mg(divided into three doses), and the mean duration of administration was 13days. All patients received concomitant intravenous treatments with carbapenem and/or ampicillin-sulbactam or piperacillin-sulbactam. The pnaumonia was observed to respond to treatment in 13 out of 20 patients. CRP, WBC count, chest X-ray, and oxygen requirement were improved. 7 out of 20 patients did not respond to treatment(2 ARDS, 1 IPF exacerbation, 2 AMI, and 1 CHF). Mean serum Creatinin values at the start and the end of nebulized colistin were 0.8mg/dl and 0.9mg/dl. There are no nephrotoxicity and any adverse events.
CONCLUSION: Adjunct nebuzized colistin is safe and effective to treat the pneumonia due to MDR gram negative pathogens.
CLINICAL IMPLICATIONS: Colistin is effective to treat pneumonia due to MDR gram negative pathogens. However intravenous colistin induce nephrotoxicity. Nebulized colistin is safe and effective to treat MDR gram negative nosocomial pneumonia.
DISCLOSURE: Hye Sook Choi, No Financial Disclosure Information; No Product/Research Disclosure Information