Efficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii

Ji Young Jang, Hye Youn Kwon, Eun Hee Choi, Won Yeon Lee, Hongjin Shim, Keumseok Bae

Research output: Contribution to journalArticle

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Abstract

Purpose Few studies have compared nebulized and intravenous (IV) colistin for multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa pneumonia. This study compared the nephrotoxicity and clinical outcomes for these two delivery routes. Methods This study retrospectively compared 95 critically ill surgical patients who were diagnosed with Acinetobacter baumannii ventilator associated pneumonia and received colistin between March 2013 and January 2016. Results The most common diagnoses were brain hemorrhage (27.4%), traumatic brain injury (20%), traumatic thoracic injury (15.8%), and secondary peritonitis (11.6%). Compared to the IV group, the nebulizer group was significantly older (60.0 vs. 67.5 years, p = 0.010), had higher APACHE II scores (16.3 vs. 19.9, p = 0.001), and more frequently had diabetes mellitus (6.8% vs. 21.6%, p = 0.043). Nephrotoxicity was more common in the IV group (60.5% vs. 15.7%, p < 0.0001). Both groups had similar microbiological and clinical outcomes (p = 0.921 and p = 0.719, respectively). Patients with nephrotoxicity exhibited prolonged IV or nebulized colistin treatment and more frequent combination with vancomycin. Nephrotoxicity was independently associated with IV delivery (odds ratio: 8.48, 95% confidence interval: 2.95–24.39, p < 0.0001). Conclusions Nebulized colistin may have less nephrotoxicity and provide similar clinical results, compared to IV colistin.

Original languageEnglish
Pages (from-to)251-256
Number of pages6
JournalJournal of Critical Care
Volume40
DOIs
Publication statusPublished - 2017 Aug 1

Fingerprint

Colistin
Ventilator-Associated Pneumonia
Acinetobacter baumannii
Critical Illness
Thoracic Injuries
APACHE
Intracranial Hemorrhages
Nebulizers and Vaporizers
Vancomycin
Peritonitis
Pseudomonas aeruginosa
Pneumonia
Diabetes Mellitus
Odds Ratio
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

@article{1ecdb5a7347941ebb8132e6d8cbbc804,
title = "Efficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii",
abstract = "Purpose Few studies have compared nebulized and intravenous (IV) colistin for multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa pneumonia. This study compared the nephrotoxicity and clinical outcomes for these two delivery routes. Methods This study retrospectively compared 95 critically ill surgical patients who were diagnosed with Acinetobacter baumannii ventilator associated pneumonia and received colistin between March 2013 and January 2016. Results The most common diagnoses were brain hemorrhage (27.4{\%}), traumatic brain injury (20{\%}), traumatic thoracic injury (15.8{\%}), and secondary peritonitis (11.6{\%}). Compared to the IV group, the nebulizer group was significantly older (60.0 vs. 67.5 years, p = 0.010), had higher APACHE II scores (16.3 vs. 19.9, p = 0.001), and more frequently had diabetes mellitus (6.8{\%} vs. 21.6{\%}, p = 0.043). Nephrotoxicity was more common in the IV group (60.5{\%} vs. 15.7{\%}, p < 0.0001). Both groups had similar microbiological and clinical outcomes (p = 0.921 and p = 0.719, respectively). Patients with nephrotoxicity exhibited prolonged IV or nebulized colistin treatment and more frequent combination with vancomycin. Nephrotoxicity was independently associated with IV delivery (odds ratio: 8.48, 95{\%} confidence interval: 2.95–24.39, p < 0.0001). Conclusions Nebulized colistin may have less nephrotoxicity and provide similar clinical results, compared to IV colistin.",
author = "Jang, {Ji Young} and Kwon, {Hye Youn} and Choi, {Eun Hee} and Lee, {Won Yeon} and Hongjin Shim and Keumseok Bae",
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Efficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii. / Jang, Ji Young; Kwon, Hye Youn; Choi, Eun Hee; Lee, Won Yeon; Shim, Hongjin; Bae, Keumseok.

In: Journal of Critical Care, Vol. 40, 01.08.2017, p. 251-256.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Efficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii

AU - Jang, Ji Young

AU - Kwon, Hye Youn

AU - Choi, Eun Hee

AU - Lee, Won Yeon

AU - Shim, Hongjin

AU - Bae, Keumseok

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Y1 - 2017/8/1

N2 - Purpose Few studies have compared nebulized and intravenous (IV) colistin for multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa pneumonia. This study compared the nephrotoxicity and clinical outcomes for these two delivery routes. Methods This study retrospectively compared 95 critically ill surgical patients who were diagnosed with Acinetobacter baumannii ventilator associated pneumonia and received colistin between March 2013 and January 2016. Results The most common diagnoses were brain hemorrhage (27.4%), traumatic brain injury (20%), traumatic thoracic injury (15.8%), and secondary peritonitis (11.6%). Compared to the IV group, the nebulizer group was significantly older (60.0 vs. 67.5 years, p = 0.010), had higher APACHE II scores (16.3 vs. 19.9, p = 0.001), and more frequently had diabetes mellitus (6.8% vs. 21.6%, p = 0.043). Nephrotoxicity was more common in the IV group (60.5% vs. 15.7%, p < 0.0001). Both groups had similar microbiological and clinical outcomes (p = 0.921 and p = 0.719, respectively). Patients with nephrotoxicity exhibited prolonged IV or nebulized colistin treatment and more frequent combination with vancomycin. Nephrotoxicity was independently associated with IV delivery (odds ratio: 8.48, 95% confidence interval: 2.95–24.39, p < 0.0001). Conclusions Nebulized colistin may have less nephrotoxicity and provide similar clinical results, compared to IV colistin.

AB - Purpose Few studies have compared nebulized and intravenous (IV) colistin for multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa pneumonia. This study compared the nephrotoxicity and clinical outcomes for these two delivery routes. Methods This study retrospectively compared 95 critically ill surgical patients who were diagnosed with Acinetobacter baumannii ventilator associated pneumonia and received colistin between March 2013 and January 2016. Results The most common diagnoses were brain hemorrhage (27.4%), traumatic brain injury (20%), traumatic thoracic injury (15.8%), and secondary peritonitis (11.6%). Compared to the IV group, the nebulizer group was significantly older (60.0 vs. 67.5 years, p = 0.010), had higher APACHE II scores (16.3 vs. 19.9, p = 0.001), and more frequently had diabetes mellitus (6.8% vs. 21.6%, p = 0.043). Nephrotoxicity was more common in the IV group (60.5% vs. 15.7%, p < 0.0001). Both groups had similar microbiological and clinical outcomes (p = 0.921 and p = 0.719, respectively). Patients with nephrotoxicity exhibited prolonged IV or nebulized colistin treatment and more frequent combination with vancomycin. Nephrotoxicity was independently associated with IV delivery (odds ratio: 8.48, 95% confidence interval: 2.95–24.39, p < 0.0001). Conclusions Nebulized colistin may have less nephrotoxicity and provide similar clinical results, compared to IV colistin.

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