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Aerosolized colistin for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria in patients without cystic fibrosis

Argyris Michalopoulos1, Sofia K Kasiakou2, Zefi Mastora3, Kostas Rellos4, Anastasios M Kapaskelis5 and Matthew E Falagas6*

Author Affiliations

1 Director, Intensive Care Unit, 'Henry Dunant' Hospital, Athens, Greece

2 Research Fellow, Alfa HealthCare, Athens, Greece

3 Attending Physician, Intensive Care Unit, 'Henry Dunant' Hospital, Athens, Greece

4 Associate Director, Intensive Care Unit, 'Henry Dunant' Hospital, Athens, Greece

5 Attending Physician, Alfa HealthCare and Department of Medicine, 'Henry Dunant' Hospital, Athens, Greece

6 Adjunct Assistant Professor of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA and Director, Infectious Diseases Clinic, Department of Medicine 'Henry Dunant Hospital', Athens, Greece

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Critical Care 2005, 9:R53-R59  doi:10.1186/cc3020


See related commentary http://ccforum.com/content/9/1/29

Published: 6 January 2005

Abstract

Introduction

The clinical and economic consequences of the emergence of multidrug-resistant Gram-negative bacteria in the intensive care unit (ICU) setting, combined with the high mortality rate among patients with nosocomial pneumonia, have stimulated a search for alternative therapeutic options to treat such infections. The use of adjunctive therapy with aerosolized colistin represents one of these. There is extensive experience with use of aerosolized colistin by patients with cystic fibrosis, but there is a lack of data regarding the use of aerosolized colistin in patients without cystic fibrosis.

Methods

We conducted the present study to assess the safety and effectiveness of aerosolized colistin as an adjunct to intravenous antimicrobial therapy for treatment of Gram-negative nosocomial pneumonia. We retrospectively reviewed the medical records of patients hospitalized in a 450-bed tertiary care hospital during the period from October 2000 to January 2004, and who received aerosolized colistin as adjunctive therapy for multidrug-resistant pneumonia.

Results

Eight patients received aerosolized colistin. All patients had been admitted to the ICU, with mean Acute Physiological and Chronic Health Evaluation II scores on the day of ICU admission and on day 1 of aerosolized colistin administration of 14.6 and 17.1, respectively. Six of the eight patients had ventilator-associated pneumonia. The responsible pathogens were Acinetobacter baumannii (in seven out of eight cases) and Pseudomonas aeruginosa (in one out of eight cases) strains. Half of the isolated pathogens were sensitive only to colistin. The daily dose of aerosolized colistin ranged from 1.5 to 6 million IU (divided into three or four doses), and the mean duration of administration was 10.5 days. Seven out of eight patients received concomitant intravenous treatment with colistin or other antimicrobial agents. The pneumonia was observed to respond to treatment in seven out of eight patients (four were cured and three improved [they were transferred to another facility]). One patient deteriorated and died from septic shock and multiple organ failure. Aerosolized colistin was well tolerated by all patients; no bronchoconstriction or chest tightness was reported.

Conclusion

Aerosolized colistin may be a beneficial adjunctive treatment in the management of nosocomial pneumonia (ventilator associated or not) due to multidrug-resistant Gram-negative bacteria.

Keywords:
apnea; bronchoconstriction; colistin; inhaled; nosocomial pneumonia