High-Loading-Dose Colistin with Nebulized Administration for Carbapenem-Resistant Acinetobacter baumannii Pneumonia in Critically Ill Patients: A Retrospective Cohort Study

Abstract

Carbapenem-resistant Acinetobacter baumannii (CRAB) infections pose a serious threat, with high morbidity and mortality rates. This retrospective cohort study, conducted at Nakornping Hospital between January 2015 and October 2022, aimed to evaluate the efficacy and safety of a high loading dose (LD) of colistin combined with nebulized colistin in critically ill patients with CRAB pneumonia. Of the 261 patients included, 95 received LD colistin, and 166 received LD colistin with nebulized colistin. Multivariate Cox regression analysis, adjusted for baseline covariates using inverse probability weighting, showed no significant difference in 30-day survival between patients who received LD colistin and those who received LD colistin with nebulized colistin (adjusted hazard ratio [aHR]: 1.17, 95% confidence interval [CI]: 0.80–1.72, p = 0.418). Likewise, there were no significant differences in clinical response (aHR: 0.93, 95% CI: 0.66–1.31, p = 0.688), microbiological response (aHR: 1.21, 95% CI: 0.85–1.73, p = 0.279), or nephrotoxicity (aHR: 1.14, 95% CI: 0.79–1.64, p = 0.492) between the two treatment groups. No significant adverse events related to nebulized colistin were reported. These findings suggest that the addition of nebulized colistin may not offer additional benefits in terms of 30-day survival, clinical or microbiological response, or nephrotoxicity in these patients.

Knowledge, Attitude, and Practices of Mothers Working as Nurses Toward Multidrug-Resistant: Impact of an Educational Program in Neonatal Intensive Care Unit

“…These factors, as well as age group and employment as nosocomial infection control personnel, regular supervision, and the number of training sessions per year, were also associated with self-reported practice. [44][45][46] Additionally, there was a study conducted by Ogoina et al 43 in Africa in Nigeria that found that overall, there was a strong relationship between age, years of experience, and antibiotic resistance knowledge. Also, a study found that there were factors influencing practice including consistent medical staff turnover, an absence of "pediatric competent" nurses and doctors, lower senior healthcare coverage after hours, and time constraints in emergency departments.…”

Clinical Characteristics and Risk Factors for Infection and Death in Critically Ill Patients with Pulmonary Infection with Elizabethkingia Spp.

“… 19 Carbapenem-resistant Enterobacteriaceae infections pose a major threat to human health due to limited treatment options. Colistin-based regimens have become a major treatment option, 32 , 33 and long courses of colistin therapy have reduced 30-day mortality in critically ill patients. 34 However, Huang et al showed that patients who received nebulized colistin had a relatively high proportion of Elizabethkingia spp.…”