scholarly journals The Potential Role of Aerosolized Colistin in the Ventilator-Associated Pneumonia Management Caused by Multidrug-Resistant Gram-Negative Bacteria: A Randomized Clinical Trial

2021 ◽  
Author(s):  
Faezeh Feizabadi ◽  
Seyed Mohammad Reza Hashemian ◽  
Zahra Mirshafiei ◽  
Farzaneh Dastan
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Multidrug Resistant ◽  
Sputum Culture ◽  
Control Group ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative ◽  
Days Of Therapy ◽  
Negative Sputum

Background: Infections caused by multidrug-resistant (MDR) pathogen have caused a resurgence of interest in colistin. To date, information about the effectiveness of Aerosolized Colistin (AS) is very limited in the treatment of Ventilator-Associated Pneumonia (VAP). The aim of this study is to evaluate the efficacy and safety of AS in conjunction with intravenous (IV) colistin in patients with VAP, caused by MDR Gram-Negative Bacteria (GNB). Methods: This parallel randomized clinical trial was conducted on patients with VAP in the Intensive Care Unit (ICU) ward. 27 patients allocated to the intervention or the control group. Patients in the intervention group received IV Colistin based on glomerular filtration rate along with aerosolized Colistin, 2 million units three times a day. In the control group, only IV Colistin was administered. For all patients, Procalcitonin (PCT), sputum culture, and Clinical Pulmonary Infection Score (CPIS) were evaluated and compared as outcome measures at the specified period of time. Results: Negative sputum culture was achieved in 9 (80%) out of 11 patients in the AS-IV Colistin group after seven days of therapy versus 9 (56.25%) out of 16 in the control group (P= 0.01). PCT and CPIS scores were not significantly different between two groups (P=0.21, P= 0.62). Furthermore, nephrotoxicity and neurotoxicity were not seen. Conclusion: AS Colistin lead to earlier negative sputum culture without increasing risk of nephrotoxicity and neurotoxicity, and could potentially be a beneficial adjunctive approach in the management of MDR-VAP.

scholarly journals A randomized clinical trial on the effectiveness of a symbiotic product to decolonize patients harboring multidrug-resistant Gram-negative bacilli

2016 ◽  
Vol 49 (5) ◽  
pp. 559-566 ◽  
Author(s):  
Mariana Correa Coelho Salomão ◽  
Mário Augusto Heluany-Filho ◽  
Mayra Gonçalves Menegueti ◽  
Marlieke Elizabeth Adriana De Kraker ◽  
Roberto Martinez ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Multidrug Resistant ◽  
Gram Negative

scholarly journals Aerosolized colistin as adjunctive treatment of ventilator-associated pneumonia due to multidrug-resistant Gram-negative bacteria: A prospective study

2008 ◽  
Vol 102 (3) ◽  
pp. 407-412 ◽  
Author(s):  
Argyris Michalopoulos ◽  
Dimitrios Fotakis ◽  
Simona Virtzili ◽  
Christodoulos Vletsas ◽  
Sylvia Raftopoulou ◽  
...  
Keyword(s):  
Prospective Study ◽  
Multidrug Resistant ◽  
Adjunctive Treatment ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative ◽  
A Prospective Study

scholarly journals Description of an effective treatment regimen for ventilator-associated pneumonia due to pandrug-resistant Providencia: a case report

Pneumologia ◽  
2020 ◽  
Vol 69 (1) ◽  
pp. 53-56
Author(s):  
Elham Pourheidar ◽  
Rezvan Hassanpour ◽  
Mehrdad Haghighi ◽  
Seyedpouzhia Shojaei ◽  
Mehran Kouchak ◽  
...  
Keyword(s):  
Clinical Signs ◽  
High Dose ◽  
Gram Negative Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Gram Negative ◽  
Treatment Regimens ◽  
Antibacterial Regimen ◽  
Negative Sputum ◽  
Effective Treatment Regimen

AbstractBecause of an increased prevalence of infections with resistant Gram-negative bacteria, finding optimal treatment regimens for these cases is one of the major healthcare concerns. Providencia is a Gram-negative bacteria belonging to the Enterobacteriaceae family. This article aims to describe an effective antibacterial regimen used for treating ventilator-associated pneumonia (VAP) with species of Providencia that are resistant to all antimicrobial classes. We present the case of a 74-year-old woman suffering from VAP caused by pandrug-resistant Providencia. The patient received high-dose intravenous meropenem (1 g every 12 h, infused over 4 h), intravenous amikacin (1,500 mg every 48 h) and nebulised amikacin (250 mg every 6 h). The dosages were calculated based on weight and renal function (GFR = 13.69 ml/min/1.73). After 23 days of treatment, following improvement in clinical signs (including fever), a drop in leucocytes counts, a higher than 80% reduction in procalcitonin levels (0.12), together with confirmed microbial eradication (negative sputum cultures), the antibacterial regimen was discontinued. In conclusion, when dealing with an infection with a pan-resistant microorganism, using combinations of antibiotics in high doses can be an option. These treatment regimens have the potential of overcoming in vitro resistance, leading to clinical improvement and microbial eradication.

scholarly journals Combination Therapy with Intravenous Colistin for Management of Infections Due to Multidrug-Resistant Gram-Negative Bacteria in Patients without Cystic Fibrosis

2005 ◽  
Vol 49 (8) ◽  
pp. 3136-3146 ◽  
Author(s):  
Sofia K. Kasiakou ◽  
Argyris Michalopoulos ◽  
Elpidoforos S. Soteriades ◽  
George Samonis ◽  
George J. Sermaides ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Hospital Mortality ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Primary Outcome Measure ◽  
Control Group ◽  
Gram Negative Bacteria ◽  
Care Hospital ◽  
Gram Negative

ABSTRACT Colistin, an antibiotic almost abandoned for intravenous administration for many years due to its reported toxicity, has been recently reintroduced in clinical practice due to the emergence of multidrug-resistant gram-negative bacteria and the lack of development of new antibiotics to combat them. To assess the safety and effectiveness of intravenous colistin, in combination with other antimicrobial agents, in the treatment of serious infections in patients without cystic fibrosis, a retrospective cohort study in a 450-bed tertiary-care hospital in Athens, Greece, was performed. Patients who were hospitalized from 1 October 2000 to 31 January 2004 and received intravenous colistin for more than 72 h were further analyzed. The primary outcome measure was the in-hospital mortality; secondary end points were the clinical outcome of the infections and the occurrence of colistin toxicity. Fifty patients received intravenous colistin with a median (mean) daily dose of 3 (4.5) million IU for 16.5 (21.3) days for the management of 54 episodes of infections due to multidrug-resistant gram-negative bacteria. The predominant infections were pneumonia (33.3%), bacteremia (27.8%), urinary tract infection (11.1%), and intra-abdominal infection (11.1%). The responsible pathogens were Acinetobacter baumannii (51.9%), Pseudomonas aeruginosa (42.6%), and Klebsiella pneumoniae (3.7%) strains (no pathogen was isolated from one case). In-hospital mortality was 24% (12/50 patients). Clinical response (cure or improvement) of the infection was observed in 66.7% of episodes (36/54). In the studied group, serum creatinine levels were decreased, at the end of colistin treatment, by an average of 0.2 ± 1.3 mg/dl compared to baseline levels. Deterioration of renal function during colistin therapy was observed in 4/50 patients (8%). Coadministration of other antimicrobial agents with spectrum against gram-negative microorganisms and the absence of a control group constitute the major limitations of this study. The use of intravenous colistin for the treatment of infections due to multidrug-resistant gram-negative bacteria appears to be safe and effective.

Sign in / Sign up

Export Citation Format

Share Document