Aerosolized antibiotics – can they save us?

Abstract

Introduction. In neonatal intensive care units, a serious complication for critical ill patients is represented by ventilator-associated pneumonia (VAP), most often caused by multiresistant Gram-negative bacteria. The treatment of this condition is very challenging, and neonatologists must take into consideration the side effects of broad-spectrum intravenous medications. According to different studies, aerosolized antibiotics could be efficient and safe for treating pulmonary infections in newborns. Case presentation. We report three cases of two extremely low birth weight (ELBW) premature babies and one late preterm with asphyxia who required long-term ventilatory support and who subsequently developed VAP, with the aggravation of their condition. Cultures from tracheal aspirates identified multiresistant Acinetobacter baumannii, rising issues regarding the therapeutic strategy. Colistin is a drug known to be active on most species of Acinetobacter in vitro, but for small premature babies there are concerns regarding its nephro- and neurotoxicity. Therefore, we chose to treat our patients with inhalatory colistimethate sodium for 14-21 days, given twice a day, as monotherapy in one case and as adjunctive therapy in the others, with clinical and bacteriological resolution. All babies could have been extubated and had a good respiratory outcome. Conclusions. In newborns with multiresistant VAP, aerosolized antibiotics can be beneficial and without systemic effects. The doses and regimens are yet to be standardized, but our experience confirms the studies that demonstrate this is a valid treatment which can be used alone or in association with intravenous antibiotics.