Chest
Original ResearchCritical CareEffect of Aerosolized Colistin as Adjunctive Treatment on the Outcomes of Microbiologically Documented Ventilator-Associated Pneumonia Caused by Colistin-Only Susceptible Gram-Negative Bacteria
Section snippets
Setting, Study Design, and Data Sources
A retrospective matched-cohort analysis was conducted in the 18-bed general ICU of a 1,400-bed teaching hospital in Rome, Italy. The protocol was approved by the Catholic University's Ethics Committee (approval number: P/237/CE/2012). Informed patient consent was not required given the study's retrospective, observational nature. Data were collected via manual review of hospital charts and computerized interrogation of the ICU and Microbiology Laboratory databases.
Population
Eligibility criteria were as
Population Characteristics and VAP Incidence
During the 8-year study period, 5,812 adults were admitted to the ICU, and > 95% received MV. Two hundred eighty-eight of the patients receiving MV (5%) developed monomicrobial VAP caused by COS GNB and were treated with IV colistin. Forty-two percent (n = 121) of these also received AS colistin, and 104 met all the criteria for enrollment in the AS-IV colistin cohort. Their characteristics and those of the age-, SAPS II-, and SOFA score-matched cohort treated with IV colistin alone are shown
Discussion
This large, retrospective, matched-cohort study of patients with VAP caused by COS GNB showed that AS-IV colistin therapy can significantly shorten the duration of MV after pneumonia onset and increase clinical cure rates, as compared with IV colistin monotherapy alone. Indeed, adjunctive AS colistin was an independent predictor of clinical cure. However, the significance of its favorable impact on microbiologic cure rates was only borderline, and it had no appreciable effects on all-cause ICU
Conclusions
To our knowledge, this is the second matched-cohort study involving direct comparison of AS-IV colistin and IV colistin regimens for treating VAP caused by COS GNB. Our findings tend to conflict with those of two earlier studies,23, 38 both conducted in populations substantially smaller than (and in one case microbiologically different from) our own. Our data indicate that in critically ill patients with VAP caused by COS GNB, AS-IV colistin (as compared with IV colistin alone) can
Acknowledgments
Author contributions: Dr Tumbarello takes responsibility for the content of the manuscript, including the data and analysis.
Dr Tumbarello: contributed to conception and design, acquisition of data, or analysis and interpretation of data; drafted the submitted article or revised it critically for important intellectual content; and provided final approval of the version to be published.
Dr De Pascale: contributed to conception and design, acquisition of data, or analysis and interpretation of
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Funding/Support: This study was partially supported by a grant from the Università Cattolica del Sacro Cuore, Linea D1 2012.
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