Prevention of Gram negative noscomial bronchopneumonia by intratracheal colistin in critically ill patients

Rouby, Jean‐Jacques; Poète, P; Lassale, E. Martin de; Nicolas, M. H.; Bodin, L.; Jarlier, Vincent; Korinek, Anne‐Marie; Viars, P.

doi:10.1007/bf01704698

Cited by 63 publications

(42 citation statements)

References 23 publications

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“…Intratracheal colistin, as opposed to inhaled colistin, has also been shown to reduce the incidence of nosocomial pneumonia by 10 to 25% in critically ill patients undergoing mechanical ventilation. Emergence of colistin-resistant organisms was not observed in this study (323).…”

Section: Nosocomial Pneumoniacontrasting

confidence: 64%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

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SUMMARYGram-negative organisms comprise a large portion of the pathogens responsible for lower respiratory tract infections, especially those that are nosocomially acquired, and the rate of antibiotic resistance among these organisms continues to rise. Systemically administered antibiotics used to treat these infections often have poor penetration into the lung parenchyma and narrow therapeutic windows between efficacy and toxicity. The use of inhaled antibiotics allows for maximization of target site concentrations and optimization of pharmacokinetic/pharmacodynamic indices while minimizing systemic exposure and toxicity. This review is a comprehensive discussion of formulation and drug delivery aspects,in vitroand microbiological considerations, pharmacokinetics, and clinical outcomes with inhaled antibiotics as they apply to disease states other than cystic fibrosis. In reviewing the literature surrounding the use of inhaled antibiotics, we also highlight the complexities related to this route of administration and the shortcomings in the available evidence. The lack of novel anti-Gram-negative antibiotics in the developmental pipeline will encourage the innovative use of our existing agents, and the inhaled route is one that deserves to be further studied and adopted in the clinical arena.

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Section: Nosocomial Pneumoniacontrasting

confidence: 64%

Inhaled Antibiotics for Gram-Negative Respiratory Infections

et al. 2016

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“…Few studies have investigated pneumonia prophylaxis with antibiotics administered to the airways in critical care [9][10][11]. ROUBY et al [9] instilled colistin within the tracheal tube and decreased the incidence of bronchopneumonia due to GNB; however, they used digestive selective decontamination in addition to tracheal instillation.…”

Section: Discussionmentioning

confidence: 99%

“…ROUBY et al [9] instilled colistin within the tracheal tube and decreased the incidence of bronchopneumonia due to GNB; however, they used digestive selective decontamination in addition to tracheal instillation. KLICK et al [10] sprayed polymyxin B in the trachea/pharynx and found decreased GNB-pneumonia in a mixed population of intubated and non-intubated patients.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have evaluated the use of polymyxin instilled to the trachea or sprayed in the pharynx for preventing Gram-negative bacteria (GNB)-pneumonia [9][10][11]. The intervention was associated with reduced pneumonia rates, although it did not lead to increasing rates of polymyxin-resistant microorganisms [9,10].…”

Section: Introductionmentioning

confidence: 99%

“…Hence, there is scepticism about using such antibiotics, topically applied in the bronchial tree, to prevent VAP. Furthermore, available data on this issue come mainly from studies in critical care settings with low levels of bacterial resistance to antibiotics [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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Nebulised colistin for ventilator-associated pneumonia prevention

et al. 2015

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We evaluated whether prophylactic nebulised colistin could reduce ventilator-associated pneumonia (VAP) rates in an intensive care unit (ICU) setting with prevalent multidrug-resistant (MDR) bacteria.We used a single-centre, two-arm, randomised, open-label, controlled trial in a 12-bed ICU in the University Hospital of Larissa, Greece. Patient inclusion criteria included mechanical ventilation of >48 h. The two arms consisted of prophylaxis with 500 000 U colistin (Col group) or normal saline (NS group), thrice daily, for the first 10 ICU days or until extubation. The primary outcome of the study was the 30-day VAP incidence.In total, 168 patients entered the study. VAP incidence was not different between Col and NS group patients (14 (16.7%) versus 25 (29.8%), respectively, p=0.07). Regarding the secondary outcomes, the intervention resulted in a lower VAP incidence density rate (11.4 versus 25.6, respectively, p<0.01), and less Gram-negative bacteria-VAP ( p=0.03) and MDR-VAP ( p=0.04). Among VAP patients (n=39), prophylaxis with inhaled colistin improved ICU survival ( p=0.016). There was no evidence of increased resistance to colistin or multidrug resistance.Our findings suggest that nebulised colistin had no significant effect on VAP incidence. @ERSpublications In a RCT, nebulised colistin prophylaxis did not decrease ventilator-associated pneumonia incidence

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