Aerosolized in combination with intravenous colistin vs. intravenous colistin in the treatment of ventilator-associated pneumonia: a matched casecontrol study
Abstract number: P1545
Kofteridis D., Valachis A., Alexopoulou C., Maraki S., Dimopoulou D., Economidou F., Mavrogeni E., Christofaki M., Sifaki L., Georgopoulos D., Samonis G.
Objectives: The incidence of ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) strains is increasing. Intravenous (IV) or aerosolized (AS) plus IV colistin have been recently used to treat these life threatening infections. However, little is known for the beneficial role of AS colistin in VAP patients. The purpose of this study was to compare the efficacy and safety of AS plus IV colistin vs only IV colistin in patients with Gram-negative MDR VAP.
Methods: A retrospective, matched casecontrol study was performed at the Intensive Care Unit of the University Hospital of Heraklion, Greece, from January 2005 through December 2008. Forty-three patients suffering of VAP diagnosed by standard criteria, caused by Gram-negative MDR as documented by positive cultures of bronchial secretions or bronchoalveolar lavage fluid, received AS plus IV colistin and were matched based on age, and APACHE II score to 43 control patients who had received only IV colistin. Patients who received at least 6 doses of AS or >3 days of IV therapy were eligible for evaluation.
Results: Demographic characteristics, clinical status, and Gram-negative isolated pathogens were similar between the two treatment groups. A. baumannii (66 cases; 77%) was the most common pathogen, followed by K. pneumoniae (12; 14%) and P. aeruginosa (8; 9.3%). One patient in the IV group had concurrent A. baumannii bacteremia, while in the AS plus IV group 2 had A. baumannii and 1 K. pneumoniae bacteremia. No colistin resistant strain was isolated from patients of either group.
No significant differences between the two groups were observed regarding eradication of pathogens (P = 0.679) clinical cure (P = 0.10) and mortality (P = 0.289). Eight patients (19%) in each treatment group developed reversible renal dysfunction. No AS colistin adverse events were recorded.
Conclusion: Addition of AS to IV colistin did not provide additional therapeutic benefit to patients with Gram-negative MDR VAP.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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