Treatment of Ventilator-Associated Pneumonia Using Intravenous Colistin Alone or in Combination with Inhaled Colistin in Critically Ill Children

被引:17
作者
Polat, Meltem [1 ]
Kara, Soner Sertan [1 ]
Tapisiz, Anil [1 ]
Tezer, Hasan [1 ]
Kalkan, Gokhan [2 ]
Dolgun, Anil [3 ]
机构
[1] Gazi Univ, Sch Med, Dept Paediat Infect Dis, Ankara, Turkey
[2] Gazi Univ, Sch Med, Dept Paediat, Intens Care Unit, Ankara, Turkey
[3] Hacettepe Univ, Sch Med, Dept Biostat, Ankara, Turkey
关键词
RESISTANT ACINETOBACTER-BAUMANNII; GRAM-NEGATIVE BACTERIA; INTENSIVE-CARE-UNIT; AEROSOLIZED COLISTIN; CYSTIC-FIBROSIS; PSEUDOMONAS-AERUGINOSA; COLISTIMETHATE SODIUM; SYSTEMIC PHARMACOKINETICS; ADJUNCTIVE TREATMENT; RESPIRATORY-TRACT;
D O I
10.1007/s40272-015-0133-5
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective The objective of this study was to compare the safety and efficacy of inhaled plus intravenous (IV) colistin with that of IV colistin alone in critically ill children with ventilator-associated pneumonia (VAP) due to colistin-only susceptible (COS) Gram-negative bacteria (GNB). Study Design and Patients This retrospective cohort study included critically ill children aged 1 month to 18 years with culture-documented monomicrobial VAP due to COS GNB. Results Fifty patients were included, and 32 patients received IV colistin alone, whereas 18 patients received inhaled plus IV colistin. No between-cohort differences were observed in clinical (p = 0.49) and microbiological outcomes (p = 0.68), or VAP-related mortality (p = 0.99). Although the bacterial eradication rates did not differ in either treatment group, the median time to bacterial eradication (TBE) was significantly shorter in the inhaled plus IV colistin group than in the IV colistin group. The additional use of inhaled colistin was the only independent factor associated with TBE, and it shortened the median TBE by 3 days. Only one patient in the IV colistin group developed reversible nephrotoxicity. Mild bronchoconstriction was observed in three patients at the time of administration of the first doses of inhaled colistin, which did not require discontinuation of treatment. Conclusions The present study has demonstrated that the addition of inhaled colistin to IV colistin led to a shorter TBE in critically ill children with VAP due to COS GNB. However, it did not lead to a significant difference in the clinical and microbiological outcomes of VAP.
引用
收藏
页码:323 / 330
页数:8
相关论文
共 41 条
[1]   Inhaled colistin for lower respiratory tract infections [J].
Antoniu, Sabina Antonela ;
Cojocaru, Ileana .
EXPERT OPINION ON DRUG DELIVERY, 2012, 9 (03) :333-342
[2]   Pharmacokinetics of inhaled colistimethate sodium (CMS) in mechanically ventilated critically ill patients [J].
Athanassa, Zoe E. ;
Markantonis, Sophia L. ;
Fousteri, Marina-Zoe F. ;
Myrianthefs, Pavlos M. ;
Boutzouka, Eleni G. ;
Tsakris, Athanassios ;
Baltopoulos, George J. .
INTENSIVE CARE MEDICINE, 2012, 38 (11) :1779-1786
[3]  
Barletta Gina-Marie, 2004, Curr Opin Crit Care, V10, P499, DOI 10.1097/01.ccx.0000144940.32521.de
[4]  
Beringer P, 2001, Curr Opin Pulm Med, V7, P434, DOI 10.1097/00063198-200111000-00013
[5]   Comparison of Intrapulmonary and Systemic Pharmacokinetics of Colistin Methanesulfonate (CMS) and Colistin after Aerosol Delivery and Intravenous Administration of CMS in Critically Ill Patients [J].
Boisson, Matthieu ;
Jacobs, Matthieu ;
Gregoire, Nicolas ;
Gobin, Patrice ;
Marchand, Sandrine ;
Couet, William ;
Mimoz, Olivier .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2014, 58 (12) :7331-7339
[6]   Outcome of ventilator-associated pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa treated with aerosolized colistin in neonates: a retrospective chart review [J].
Celik, Istemi Han ;
Oguz, Serife Suna ;
Demirel, Gamze ;
Erdeve, Omer ;
Dilmen, Ugur .
EUROPEAN JOURNAL OF PEDIATRICS, 2012, 171 (02) :311-316
[7]  
Clinical and Laboratory Standards Institute, 2007, M100S17 CLSI
[8]   Inhaled Colistin for the Treatment of Tracheobronchitis and Pneumonia in Critically Ill Children Without Cystic Fibrosis [J].
Falagas, Matthew E. ;
Sideri, Georgia ;
Korbila, Ioanna P. ;
Vouloumanou, Evridiki K. ;
Papadatos, John H. ;
Kafetzis, Dimitris A. .
PEDIATRIC PULMONOLOGY, 2010, 45 (11) :1135-1140
[9]   Colistin: The revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections [J].
Falagas, ME ;
Kasiakou, SK .
CLINICAL INFECTIOUS DISEASES, 2005, 40 (09) :1333-1341
[10]   Colistin for the treatment of ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria: A systematic review and meta-analysis [J].
Gua, Wan-Jie ;
Wang, Fei ;
Tang, Lu ;
Bakker, Jan ;
Liu, Jing-Chen .
INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, 2014, 44 (06) :477-485