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Mario Tumbarello, MD; Gennaro De Pascale, MD; Massimo Antonelli, MD
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From the Institute of Infectious Diseases (Dr Tumbarello) and Department of Intensive Care and Anesthesiology (Dr De Pascale and Prof Antonelli), Università Cattolica del Sacro Cuore.

Correspondence to: Mario Tumbarello, MD, Università Cattolica del Sacro Cuore, Institute of Infectious Diseases, Largo A. Gemelli 8, Rome, Italy 00168; e-mail: tumbarello@rm.unicatt.it


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2014;145(4):927. doi:10.1378/chest.14-0098
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To the Editor:

We thank Drs Myrianthefs and Baltopoulos for the data reported in their letter. They used the results of our recently published study in CHEST1 to evaluate the different economic outcomes of patients in the ICU with ventilator-associated pneumonia (VAP) treated with IV colistin monotherapy or aerosolized plus IV (AS + IV) colistin therapy in a Greek hospital. They found that 7-day AS + IV colistin therapy is less expensive than 10-day IV colistin monotherapy. They also found that a considerable cost benefit may occur as a result of fewer days under mechanical ventilation (MV) and shorter length of ICU stay. Of course, we agree with them that the use of AS + IV colistin therapy can be a cost-effective strategy in patients with VAP, shortening the duration of therapy, MV, and ICU stay and achieving better clinical outcomes.

Because our study was retrospective, a proper cost assessment was not completely reliable, especially in the absence of parameters whose prospective collection would have been important (ie, those related to nurse workload). Consequently, we preferred to not speculate on the cost-benefit analysis. As the total length of hospitalization is the main cost driver, in our institution a considerable cost benefit would also be expected as a result of fewer days under MV and shorter ICU length of stay. In conclusion, the cost-effectiveness of AS + IV colistin therapy for the management of VAP caused by multidrug-resistant gram-negative bacteria should be an important end point to be further investigated in multicenter prospective randomized clinical trials.

References

Tumbarello M, De Pascale G, Trecarichi EM, et al. Effect of aerosolized colistin as adjunctive treatment on the outcomes of microbiologically documented ventilator-associated pneumonia caused by colistin-only susceptible gram-negative bacteria. Chest. 2013;144(6):1768-1775. [CrossRef]
 

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References

Tumbarello M, De Pascale G, Trecarichi EM, et al. Effect of aerosolized colistin as adjunctive treatment on the outcomes of microbiologically documented ventilator-associated pneumonia caused by colistin-only susceptible gram-negative bacteria. Chest. 2013;144(6):1768-1775. [CrossRef]
 
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