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

Hsieh, Tai Chin; Chen, Fu Lun; Ou, Tsong Yih; Jean, Shio Shin; Lee, Wen Sen

doi:10.1016/j.jmii.2014.08.009

Cited by 30 publications

(25 citation statements)

References 25 publications

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“…However, these data have not been confirmed in other studies [104,170]. A recent retrospective study showed an acceptable efficacy of nebulized colistin in patients with extremely resistant A. baumanii pneumonia but was not effective in patients with respiratory tract colonization [171].…”

Section: Should Inhaled Antibiotics Be Prescribed To Donors or Recipimentioning

confidence: 82%

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Aguado

Silva

Fernández‐Ruiz

et al. 2018

Transplantation Reviews

124

139

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Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate's phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.

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Section: Should Inhaled Antibiotics Be Prescribed To Donors or Recipimentioning

confidence: 82%

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Aguado

Silva

Fernández‐Ruiz

et al. 2018

Transplantation Reviews

124

139

View full text Add to dashboard Cite

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“…In our population of patients with KPC-Kp septic shock, a carbapenem was the most used antibiotic, mainly in combination with colistin, tigecycline, and/or gentamicin. On the other hand, a carbapenem was used in combination with colistin and/or rifampin for the treatment of MDR-AB infections (27)(28)(29). Despite the observation of only 1 patient with MDR-AB infection due to a colistinresistant strain, a very low proportion of patients were treated with 2 or more antibiotics showing in vitro activity against the isolates of MDR-AB; this probably explains the very high mortality rates observed in this population.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Septic Shock Due to Multidrug-Resistant Acinetobacter baumannii or Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae in Intensive Care Unit Patients

Russo

Giuliano

Ceccarelli

et al. 2018

Antimicrob Agents Chemother

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A significant cause of mortality in the intensive care unit (ICU) is multidrug-resistant (MDR) Gram-negative bacteria, such as MDR (MDR-AB) and carbapenemase-producing (KPC-Kp). The aim of the present study was to compare the clinical features, therapy, and outcome of patients who developed septic shock due to either MDR-AB or KPC-Kp. We retrospectively analyzed patients admitted to the ICU of a teaching hospital from November 2010 to December 2015 who developed septic shock due to MDR-AB or KPC-Kp infection. Data from 220 patients were analyzed: 128 patients (58.2%) were diagnosed with septic shock due to KPC-Kp, and 92 patients (41.8%) were diagnosed with septic shock due to MDR-AB. The 30-day mortality rate was significantly higher for the MDR-AB group than the KPC-Kp group (84.8% versus 44.5%, respectively; < 0.001). Steroid exposure and pneumonia were associated with MDR-AB infection, whereas hospitalization in the previous 90 days, primary bacteremia, and KPC-Kp colonization were associated with KPC-Kp infection. For patients with KPC-Kp infections, the use of ≥2 -active antibiotics as empirical or definitive therapy was associated with higher 30-day survival, while isolation of colistin-resistant strains was linked to mortality. Patients with MDR-AB infections, age>60 years, and a simplified acute physiology score II (SAPS II) of >45 points were associated with increased mortality rates. We concluded that septic shock due to MDR-AB infection is associated with very high mortality rates compared to those with septic shock due to KPC-Kp. Analysis of the clinical features of these critically ill patients might help physicians in choosing appropriate empirical antimicrobial therapy.

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“…[ 23 ] XDR-Acb pneumonia was defined as new infiltrates or consolidation on radiographic evidence, as well as the consistent sputum Gram stain finding (> 25 leukocytes/low power field [LPF], < 10 epithelial cells/LPF, and numerous gram-negative pleomorphic coccobacilli seen by high power field of smear) and culture of tracheal aspirate growing heavy XDR-Acb complex (the microbiological definition is seen as follows). [ 4 , 12 ] Using the propensity matching score, we selected the control group patients who received AS-CMS alone based on age (± 5 years) and Acute Physiology and Chronic Health Evaluation (APACHE) II score (± 4 points) by the computers. An AS-CMS dose of 2 million international units thrice per day was used, and a TGC loading dose of 100 mg and 50 mg every 12 hours was administered.…”

Section: Methodsmentioning

confidence: 99%

“…[ 7 ] However, the colistin concentration in lung tissue is low when it is administered intravenously in mice and humans. [ 8 , 9 ] Aerosolized CMS (AS-CMS) was prescribed as either an adjuvant drug [ 10 – 12 ] or monotherapy [ 13 ] for XDR-Acb pneumonia with clinically variable successful rates. Nevertheless, a survey on the use of CMS in treating patients with microbiologically documented ventilator-associated pneumonia (VAP) addressed that AS-CMS therapy was the only independent predictor of clinical cure in patients with VAP.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcomes of patients with non-bacteremic pneumonia caused by extensively drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex isolates

et al. 2018

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Few therapeutic options exist for various infections caused by extensively drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (XDR-Acb) complex isolates, including pneumonia. This study investigated the clinical efficacy between aerosolized colistimethate sodium (AS-CMS, 2 million units thrice a day) treatment alone or in combination with standard-dose tigecycline (TGC) in patients with non-bacteremic pneumonia due to XDR-Acb, and explored the factors influencing patients’ 30-day mortality.A 1:1 case (n = 106; receiving TGC plus AS-CMS) control (receiving AS-CMS alone with matching scores) observational study was conducted among adult patients with non-bacteremic XDR-Acb complex pneumonia in a Taiwanese medical center from January 2014 through December 2016. The clinically relevant data were retrospectively recorded. The primary endpoint was 30-day case fatality. Secondary endpoints investigated that if the co-morbidities, XDR-A. baumannii as a pneumonic pathogen, therapy-related factors, or airway colonization with colistin-resistant Acb negatively influenced the 14-day clinical condition of enrolled patients.A higher 30-day mortality rate was noted among the group receiving combination therapy (34.0% vs 22.6%; P = .17). The ≥7-day AS-CMS therapy successfully eradicated > 90% of airway XDR-Acb isolates. Nevertheless, follow-up sputum specimens from 10 (6.4% [10/156]) patients were colonized with colistin-resistant Acb isolates. After the conditional factors were adjusted by multivariate logistic analysis, the only factor independently predicting the 30-day case-fatality was the failure of treating XDR-Acb pneumonia at 14 days (adjusted odds ratio [aOR] = 38.2; 95% confidence interval [CI] = 9.96–142.29; P < .001). Cox proportional regression analysis found that chronic obstructive pulmonary disease (COPD) (adjusted hazard ratio [aHR] = 2.08; 95% CI = 1.05–4.10; P = .035), chronic renal failure (aHR = 3.00; 95% CI = 1.52–5.90; P = .002), non-invasive ventilation use (aHR = 2.68; 95% CI = 1.37–5.25; P = .004), and lack of TGC therapy (aHR = 0.52; 95% CI = 0.27–1.00; P = .049) adversely influenced the 14-day clinical outcomes. Conversely, the emergence of colistin-resistant Acb isolates in the follow-up sputum samples was not statistically significantly associated with curing or improving XDR-Acb pneumonia.In conclusion, aggressive pulmonary hygiene care, the addition of TGC, and corticosteroid dose tapering were beneficial in improving the 14-day patients’ outcomes.

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

Abstract: Aerosolized CMS therapy has acceptable efficacy for XDRAB pneumonia, but no proven efficacy for XDRAB airway colonization.

Cited by 30 publications

References 25 publications

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Comparison of Septic Shock Due to Multidrug-Resistant Acinetobacter baumannii or Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae in Intensive Care Unit Patients

Treatment outcomes of patients with non-bacteremic pneumonia caused by extensively drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex isolates

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