Use of high-dose IV and aerosolized colistin for the treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia: do we really need this treatment?

Intravenous polymyxins: Revival with puzzle

“…intravenous polymyxins alone in MDR GNB infections, most of which were pneumonias. It's indicated that the mortality ranged from 0% to 74.3% (4,21,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), clinical response (cure and improvement) rate 7-82.1%, and microbiological eradication 27.3-73.9% (24,(33)(34)(35)(36)(37)(38). In respect to the colistin only susceptible strains, it's reported that the mortality in hospitals of intravenous colistin monotherapy was 50% (16/32) (Figure 2), 11 patients died in Intensive Care Unit (ICU) (39), and clinical cure was obtained in 82.1% of infectious episodes (23/28) and bacteriological clearance was achieved in 73.9% (17/23) of the cured infectious episodes (38).…”

“…Kalin G et al found that the clinical cure rate of colistin was 30 % in the normal-dose (2.5 mg/kg every 12 h (maximum 300 mg)) and low-dose (adjusted according to creatinine clearance) groups, whereas the rate was only 7% in the high-dose (2.5 mg/kg every 6 h (maximum 600 mg)) group (33). The bacteriological clearance rates were 64, 65, and 75% in the high-dose, normal-dose, and low-dose groups, respectively.…”

“…This maybe because these data are generated from a number of small, non-comparative studies or case series, with heterogeneous patient populations, and varying dosing schemes. It's also because different definitions of nephrotoxicity, such as AKIN (Acute Kidney Injury Network) criteria (51,93), RIFLE (33,34,47,53,54), KIDIGO (56), and other criteria (19,36,42). So it's difficult to compare nephrotoxicity between trials.…”

Efficacy and Safety of Aerosolized Colistin in the Treatment of Ventilator-Associated Pneumonia: A Systematic Review and Meta-analysis

“…총 9개의 문헌 (randomized controlled trial 1개 27) , cohort 5개 [22][23][24][25][26] , case-control 3개 24,28,30) ) 중 8개 문헌에 대해서는 Newcastle-Ottawa Quality Assessment Scale을 1개의 문헌에 대해서는 Cochrane risk-of-bias tool을 사용하여 quality를 평 가하였고 그 결과는 Table 1에 제시하였다. 각 문헌의 quality assessment 결과 한 연구 참고문헌…”

Right first time!

“…In the recent years, MDR is a growing problem in ICU worldwide (17)(18)(19). In the era of MDR pathogens, initially appropriate antibiotic therapy is more complicated that causes poor outcome (20)(21)(22)(23). Zilberberg et al (24) indicated that MDR pathogen was the strongest predictor of initial inappropriate antibiotic therapy with an excessive impact (13.05-fold) on mortality.…”