Effectiveness of Adjunctive Inhaled Colistin in Treatment of Ventilator Associated Pneumonia

Abstract

Ventilator-Associated pneumonia (VAP) represents a major health problem in mechanically ventilated patients in intensive care units (ICUs). Aerosolized colistin could represent an adjunctive treatment to intravenous antibiotics in VAP. To evaluate the safety and efficacy of adjunctive inhaled colistin in treatment of patients with Gram-negative VAP compared to the conventional intravenous antibiotic regimen alone. This prospective randomized controlled study was conducted from July 2013 to August 2014 at Kasr El-Aini Medical ICU. Our study included a total number of 50 cases with VAP randomly assigned into two equal groups; a study group (who received the conventional systemic IV antibiotic regimen plus adjunctive inhaled colistin) and a control group (who received the conventional systemic IV antibiotic regimen alone). 76% of the patients were men with severe underlying co-morbidities. The main causative organisms of VAP were Klebsiella spp. (32%), Acinetobacter spp. (26%) and Pseudomonas spp. (24%). Patients in the study group had significantly more favourable microbiological outcome when compared with patients in the control group (80% versus 52%, P=0.03). No adverse effects related to inhaled colistin (nephrotoxicity, neurotoxicity, bronchoconstriction, cough, apnea or chest tightness) were recorded. Inhaled colistin seems to be safe and efficient as an adjunctive treatment for patients with Gram-negative VAP.