SESSION TITLE: Bronchiectasis
SESSION TYPE: Slide Presentations
PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM
PURPOSE: To assess the effectiveness of inhaled colistin in elderly patients with bronchiectasis and chronic bronchial PA infection in reducing hospital readmissions
METHODS: Prospective, controlled and open label We included patients with HRCT diagnosed bronchiectasis and persistence of PA, after an acute exacerbation admission and appropriate antimicrobial therapy. All patients received education, physiotherapy and exercise training. Intervention group received also nebulized colistin 1mill UI twice a day for one year We collected data on demographics, clinical and functional characteristics, admissions in prior year and sputum microbiology. Patients were followed every two months for one year, evaluating readmissions, microbiological results, functional tests and deaths.
RESULTS: 39 patients were included, 20 received nebulized colistin and 19 conventional therapy. There were no differences between the two groups in baseline clinical and functional characteristics or previous hospital stay. Mean age was 77.7+/-5, Charlson index 2,85 and FEV1% 41,3+/-15. Five patients (25%) stopped the nebulized treatment because adverse effects. Pseudomonas aeruginosa was eradicated in 45% of the colistin treated patients and in only one of the control group (statistically significant) but at the end of the study year, there were no differences in the number of hospital admission (2,7+/-3 and 1,6+/-1,7) or days of stay (23+/-20 and 19+/-31) No differences in lung function or clinical symptoms were detected between both groups No significant changes were observed in PA antibiotic sensitivity or in sputum flora
CONCLUSIONS: More patients in the treatment group achieved Pseudomonas eradication, but we could not demonstrate benefits in clinical symptoms, lung function or use of healthcare resources in our elderly patients. Adverse effects were frequent.
CLINICAL IMPLICATIONS: Bronchiectasis is the end result of several different illnesses and a frequent cause of admission for elderly patients and chronic respiratory diseases. Although many guidelines recommend treatment with inhaled antibiotics in non cystic fibrosis bronchiectasis with PA chronic infection, there is limited evidence, and we could not find benefits with nebulized colistin in elderly patients with chronic severe obstruction. Further studies are needed in order to identify factors associated to response, or subgroups of patients with bronchiectasis and chronic infection with PA who benefit from (expensive) treatments with inhaled antibiotics
DISCLOSURE: The following authors have nothing to disclose: Eva Tabernero, Pilar Gil, Ramon Alkiza, Javier Garros, Anibal Hernandez, Juan Luis Artola
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