Abstract
Study background: The purpose of this study was to evaluate recent strategies for anti-infective treatment in patients suffering from ventilator-associated respiratory infections caused by P. aeruginosa and to assess the riskbenefit profile of inhaled tobramycin.Methods: Electronic health records of patients suffering from respiratory infections caused by P. aeruginosa from 2011-2014 were retrospectively screened.Results: In 81 patients, P. aeruginosa was found in respiratory secretions, of which 26 patients suffered from ventilator-associated pneumonia (VAP), whereas 55 patients only fulfilled criteria of ventilator-associated tracheitis (VAT). Inhaled tobramycin was used in 14 patients with VAP and 31 patients with VAT. In this context, inhaled tobramycin was shown to be safe (e.g. no bronchoconstriction or systemic toxicity) and did not result in an increase of tobramycin resistant strains in respiratory secretions at 90 days following study inclusion. However, a clear clinical benefit (e.g. reduced need for i.v. antibiotics) could not be shown.\Conclusion: Inhaled tobramycin was shown to be a suitable approach with a favorable risk profile to treat patients suffering from respiratory infections (VAP, VAT) caused by P. aeruginosa. The clinical benefit needs to be reevaluated in a larger prospective investigation.
Highlights
Hospital-acquired pneumonia (HAP) is one of the most common types of nosocomial infection [1-3]
This approach has been well-examined in patients with cystic fibrosis [14], the evidence for the use of inhaled antibiotics in critically ill patients suffering from Ventilator-associated pneumonia (VAP) with P. aeruginosa is restricted [15,16]
26 patients (32.1%) with a positive culture for P. aeruginosa were found to suffer from VAP, whereas 55 (67.9%) patients had to be classified as suffering from ventilator-associated tracheitis (VAT)
Summary
Hospital-acquired pneumonia (HAP) is one of the most common types of nosocomial infection [1-3] It has a considerable economic impact since its occurrence is associated with a prolonged hospital stay [1,2]. The potential risks of inhaled antibiotics need to be taken into account (e.g. the development of resistance, undesirable side effects like bronchoconstriction or coughing attacks, and insufficient antibiotic concentrations in unventilated alveoli). This approach has been well-examined in patients with cystic fibrosis [14], the evidence for the use of inhaled antibiotics in critically ill patients suffering from VAP with P. aeruginosa is restricted [15,16]
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