Non-Inferiority of Nebulized Colistin Compared with Conventional Systemic Antibiotics for the Treatment of Ventilator-Associated Pneumonia

Abstract

Background: In the present study, our objective was to determine whether nebulized colistin as an adjunctive therapy to conventional intravenous antibiotics of Ventilator-associated pneumonia (VAP) caused by multi-drug resistant (MDR) was safe and beneficial in critically ill patients. Methods: A prospective matched case-control study was performed at the ICUs of the University Hospital of Isfahan. Iran, from January to June 2017. Twenty patients with VAP due to MDR gram-negative bacilli received nebulized colistin and were matched on the basis of age and acute physiology and chronic health evaluation II (APACHE) score with 20 control patients who had received systemic antibiotic therapy according to their responsible physicians. Results: The baseline characteristics of the patients and conventional therapy of VAP in both groups were comparable. Most of the cases of VAP were caused by MDR A. baumannii (N=25, 75) and Klebsiella pneumonia (N=10, 50). No significant difference between the groups were observed regarding clinical cure (P: 0.6) and mortality (P: 0.25). The rate of pathogen eradication was significantly better in case patients (75 vs. 5, P: 0.0001). Renal impairment was observed in 10 of cases and in 15 of control patients (P: 0.6). Conclusion: Our finding suggests that inhaled colistin monotherapy even without concurrent administration of intravenous colistin, seems to be an effective and safe treatment option for treatment of VAP due to MDR A. baumannii. This mode for colistin administration may deserve further consideration.