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Abdellatif S, Trifi A, Daly F, et al. Efficacy and toxicity of aerosolised colistin in ventilator-associated pneumonia: a prospective, randomised trial. Ann Intensive Care. 2016;6(1):26doi: 10.1186/s13613-016-0127-7.
Abdellatif, S., Trifi, A., Daly, F., Mahjoub, K., Nasri, R., & Ben Lakhal, S. (2016). Efficacy and toxicity of aerosolised colistin in ventilator-associated pneumonia: a prospective, randomised trial. Annals of intensive care, 6(1), 26. https://doi.org/10.1186/s13613-016-0127-7
Abdellatif, Sami, et al. "Efficacy and toxicity of aerosolised colistin in ventilator-associated pneumonia: a prospective, randomised trial." Annals of intensive care vol. 6,1 (2016): 26. doi: https://doi.org/10.1186/s13613-016-0127-7
Abdellatif S, Trifi A, Daly F, Mahjoub K, Nasri R, Ben Lakhal S. Efficacy and toxicity of aerosolised colistin in ventilator-associated pneumonia: a prospective, randomised trial. Ann Intensive Care. 2016 Dec;6(1):26. doi: 10.1186/s13613-016-0127-7. Epub 2016 Mar 31. PMID: 27033711; PMCID: PMC4816935.
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Ann Intensive Care. 2016 Dec;6(1):26. doi: 10.1186/s13613-016-0127-7. Epub 2016 Mar 31.

Efficacy and toxicity of aerosolised colistin in ventilator-associated pneumonia: a prospective, randomised trial.

Annals of intensive care

Sami Abdellatif, Ahlem Trifi, Foued Daly, Khaoula Mahjoub, Rochdi Nasri, Salah Ben Lakhal

Affiliations

  1. Medical Intensive Care Unit, Tunis Faculty of Medicine, El Manar University, University Hospital Center La Rabta, Tunis, Tunisia.
  2. Medical Intensive Care Unit, Tunis Faculty of Medicine, El Manar University, University Hospital Center La Rabta, Tunis, Tunisia. [email protected].

PMID: 27033711 PMCID: PMC4816935 DOI: 10.1186/s13613-016-0127-7

Abstract

BACKGROUND: Cases of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) gram-negative bacilli (GNB) mainly Acinetobacter baumannii, Pseudomonas aeruginosa and enterobacteria are common in hospitalised patients of Tunisian intensive care units (ICUs). Parenteral colistin has been used for the therapy of VAP caused by MDR GNB at Tunisian hospitals over the past few years with a favourable clinical response. However, its use fell out of favour because of the reported drug-related nephrotoxicity and neurotoxicity.

OBJECTIVES: To determine whether aerosolised (AS) colistin was beneficial and safe in therapy of gram-negative VAP.

METHODS: This was a randomised, single-blind study, in 149 critically ill adults who developed gram-negative VAP. Included patients were divided into two groups whether they received AS colistin (intervention group; n = 73) or intravenous (IV) colistin (control group; n = 76). AS colistin was given as 4 million units (MU) by nebulisation three times per 24 h. IV colistin was given as a loading dose of 9 MU followed by 4.5 MU two times per 24 h. Patients were followed during 28 days. Primary outcome was cure of VAP assessed at day 14 of therapy and defined as resolution of clinical signs of VAP and bacteriological eradication. Secondary outcomes were incidence of acute renal failure (ARF), mechanical ventilation length, ICU length of stay and 28-day mortality. Results were analysed based on intention-to-treat concept.

RESULTS: The patient's baseline characteristics and distribution of pathogens VAP in both groups were similar. The clinical cure rate was 67.1 % in AS group and 72 % in IV group (p = 0.59). When administered in monotherapy or in combination, the AS regimen was as effective as IV regimen. Patients in AS group had significantly lower incidence of ARF (17.8 vs 39.4 %, p = 0.004), more favourable improvement of P/F ratio (349 vs 316 at day 14, p = 0.012), shortened time to bacterial eradication (TBE) (9.89 vs 11.26 days, p = 0.023) and earlier weaning from ventilator in ICU survivors with a mean gain in ventilator-free days of 5 days. No difference was shown in the length of stay and the 28-day mortality.

CONCLUSION: Aerosolised colistin seems to be beneficial. It provided a therapeutic effectiveness non-inferior to parenteral colistin in therapy of MDR bacilli VAP with a lower nephrotoxicity, a better improvement of P/F ratio, a shortened bacterial eradication time and earlier weaning from ventilator in ICU survivors. Trial registration ClinicalTrials.gov Identifier: NCT02683603.

Keywords: Aerosol; Colistin; Intravenous; Nephrotoxicity; Ventilator-associated pneumonia

References

  1. Clin Microbiol Infect. 2010 Aug;16(8):1230-6 - PubMed
  2. J Clin Anesth. 1993 May-Jun;5(3):212-5 - PubMed
  3. Int J Antimicrob Agents. 2015 Mar;45(3):221-33 - PubMed
  4. Intensive Care Med. 2009 Oct;35(10):1792-800 - PubMed
  5. Anesthesiology. 2012 Dec;117(6):1364-80 - PubMed
  6. Int J Antimicrob Agents. 2014 Dec;44(6):477-85 - PubMed
  7. Paediatr Drugs. 2015 Aug;17(4):323-30 - PubMed
  8. Expert Opin Drug Deliv. 2012 Mar;9(3):333-42 - PubMed
  9. Int J Infect Dis. 2013 Dec;17(12):e1225-8 - PubMed
  10. Respir Care. 2012 Aug;57(8):1226-33 - PubMed
  11. Clin Infect Dis. 2010 Aug 1;51 Suppl 1:S131-5 - PubMed
  12. J Antimicrob Chemother. 2007 Dec;60(6):1216-26 - PubMed
  13. Int J Antimicrob Agents. 2006 Oct;28(4):366-9 - PubMed
  14. BMC Infect Dis. 2014 Feb 24;14:102 - PubMed
  15. Pediatr Pulmonol. 2010 Nov;45(11):1121-34 - PubMed
  16. Clin Infect Dis. 2012 Mar 1;54(5):670-80 - PubMed
  17. Ann Intern Med. 1970 Jun;72(6):857-68 - PubMed
  18. Intensive Care Med. 2010 May;36(5):781-9 - PubMed
  19. JAMA. 1964 Nov 2;190:421-4 - PubMed
  20. Ann Pharmacother. 2010 Oct;44(10):1665-8 - PubMed
  21. Clin Infect Dis. 2012 Jun;54(12):1720-6 - PubMed
  22. Chest. 2013 Dec;144(6):1768-75 - PubMed
  23. Ann Pharmacother. 2016 Feb;50(2):133-40 - PubMed
  24. Clin Infect Dis. 2010 Dec 1;51(11):1238-44 - PubMed
  25. Intensive Care Med. 2004 May;30(5):844-52 - PubMed
  26. Indian J Crit Care Med. 2014 Jul;18(7):427-30 - PubMed
  27. Ann Pharmacother. 2005 Jan;39(1):39-44 - PubMed
  28. Intensive Care Med. 2010 Jul;36(7):1147-55 - PubMed
  29. Am J Respir Crit Care Med. 2011 Nov 15;184(10):1133-9 - PubMed
  30. Int J Antimicrob Agents. 2012 Feb;39(2):180-1 - PubMed
  31. Anesthesiology. 2012 Dec;117(6):1335-47 - PubMed
  32. Microb Drug Resist. 2011 Mar;17(1):25-30 - PubMed
  33. Respir Med. 1999 Jul;93(7):476-80 - PubMed
  34. Intensive Care Med. 2007 Sep;33(9):1524-32 - PubMed
  35. Int J Antimicrob Agents. 2004 Oct;24(4):405-8 - PubMed
  36. Antimicrob Agents Chemother. 2014 May;58(5):2570-9 - PubMed
  37. Crit Care. 2006 Feb;10(1):R27 - PubMed
  38. Am J Respir Crit Care Med. 2000 Jul;162(1):328-30 - PubMed
  39. Crit Care Med. 2015 Mar;43(3):527-33 - PubMed
  40. Chemotherapy. 2016;61(4):190-6 - PubMed
  41. Crit Care Med. 2008 Mar;36(3):807-11 - PubMed

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