Colistin inhalation monotherapy for ventilator-associated pneumonia of<i>Acinetobacter baumannii</i>in prematurity

Kang, Chia-Hao; Tsai, Chih-Min; Wu, Tin-Hsin; Wu, Hsien-Ming; Chung, Mei‐Ing; Chen, Chih‐Cheng; Huang, Yi‐Chuan; Liu, Shih-Feng; Liao, Da-Ling; Niu, Chi‐Chien; Lee, Chen‐Hsiang; Yu, Hong‐Ren

doi:10.1002/ppul.22750

Cited by 35 publications

(24 citation statements)

References 45 publications

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“…8,9 recently, we reported that nebulized cmS was successful in the treatment of neonates with VaP caused by mDr A. baumannii. 2 Similar results have been described by celik et al 10 and Kang et al, 11 who successfully treated neonates and preterm infants with VaP because of mDr A. baumannii and P. aeruginosa. the dosage regimens reported in the literature vary from author to author and are chosen empirically.…”

supporting

confidence: 81%

Pulmonary and Systemic Pharmacokinetics of Colistin Following a Single Dose of Nebulized Colistimethate in Mechanically Ventilated Neonates

Nakwan

Lertpichaluk

Chokephaibulkit

et al. 2015

Pediatric Infectious Disease Journal

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The purpose of this study was to evaluate the pulmonary and systemic pharmacokinetics of colistin following a single dose of nebulized colistimethate sodium (CMS) in mechanically ventilated neonates. We administered a single dose of nebulized CMS (approximately 120,000 IU/kg of CMS, equivalent to 4 mg/kg colistin base activity) to 6 ventilated neonates with ventilator-associated pneumonia. The median gestational age was 39 weeks (range, 32-39 weeks). Mean (± SD) tracheal aspirate colistin maximum concentration (Cmax), area under the concentration-time curve (AUC 0-24) and t1/2 were 24.0 ± 8.2 μg/mL, 147.6 ± 53.5 μg · hours/mL and 9.8 ± 5.5 hours, respectively. The plasma concentrations of colistin were low. In neonates, a single nebulized dose of CMS (120,000 IU) resulted in high local concentrations for at least 12 hours and low systemic concentrations of colistin. Twice daily nebulization might be more appropriate.

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supporting

confidence: 81%

Pulmonary and Systemic Pharmacokinetics of Colistin Following a Single Dose of Nebulized Colistimethate in Mechanically Ventilated Neonates

Nakwan

Lertpichaluk

Chokephaibulkit

et al. 2015

Pediatric Infectious Disease Journal

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“…Thus, at this point, the data are mixed regarding whether adding inhaled colistin to systemic therapy improves clinical cure. Importantly, several studies have reported favorable outcomes of patients with ventilator-associated pneumonia caused by highly resistant Gram-negative bacteria, including XDR A. baumannii, treated with monotherapy inhalational colistin without adjunctive systemic therapy (255,259,261,263). However, these results should be viewed cautiously, as cases were nonrandomized leading to a potential selection bias.…”

Section: Current Treatment Optionsmentioning

confidence: 57%

“…Furthermore, resistance has emerged during therapy, although with variable frequency depending on the case series (255,261,263).…”

Section: Current Treatment Optionsmentioning

confidence: 99%

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

et al. 2017

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SUMMARY Acinetobacter is a complex genus, and historically, there has been confusion about the existence of multiple species. The species commonly cause nosocomial infections, predominantly aspiration pneumonia and catheter-associated bacteremia, but can also cause soft tissue and urinary tract infections. Community-acquired infections by Acinetobacter spp. are increasingly reported. Transmission of Acinetobacter and subsequent disease is facilitated by the organism's environmental tenacity, resistance to desiccation, and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. primarily stem from evasion of rapid clearance by the innate immune system, effectively enabling high bacterial density that triggers lipopolysaccharide (LPS)–Toll-like receptor 4 (TLR4)-mediated sepsis. Capsular polysaccharide is a critical virulence factor that enables immune evasion, while LPS triggers septic shock. However, the primary driver of clinical outcome is antibiotic resistance. Administration of initially effective therapy is key to improving survival, reducing 30-day mortality threefold. Regrettably, due to the high frequency of this organism having an extreme drug resistance (XDR) phenotype, early initiation of effective therapy is a major clinical challenge. Given its high rate of antibiotic resistance and abysmal outcomes (up to 70% mortality rate from infections caused by XDR strains in some case series), new preventative and therapeutic options for Acinetobacter spp. are desperately needed.

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“…8 Therefore, aerosolized CMS has become a reasonable choice for minimizing systemic exposure and optimizing the benefiterisk ratio of therapy. Aerosolized CMS has been used as a monotherapy 9,10 or as an adjuvant to intravenous antibiotics in XDRAB pneumonia. 5,11 Some hospitals in Taiwan have also employed aerosolized CMS for eradication of XDRAB as part of their infection control measures.…”

Section: Introductionmentioning

confidence: 99%

Role of aerosolized colistin methanesulfonate therapy for extensively-drug-resistant Acinetobacter baumannii complex pneumonia and airway colonization

Hsieh

Chen

et al. 2016

Journal of Microbiology, Immunology and Infection

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Colistin inhalation monotherapy for ventilator-associated pneumonia ofAcinetobacter baumanniiin prematurity

Abstract: Aerosolized colistin may be used as monotherapy for VAP due to A. baumannii infection in pre-term infants. A larger controlled study is warranted to corroborate the findings.

Cited by 35 publications

References 45 publications

Pulmonary and Systemic Pharmacokinetics of Colistin Following a Single Dose of Nebulized Colistimethate in Mechanically Ventilated Neonates

Pulmonary and Systemic Pharmacokinetics of Colistin Following a Single Dose of Nebulized Colistimethate in Mechanically Ventilated Neonates

Clinical and Pathophysiological Overview of Acinetobacter Infections: a Century of Challenges

Role of aerosolized colistin methanesulfonate therapy for extensively-drug-resistant Acinetobacter baumannii complex pneumonia and airway colonization

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