Role of nebulized colistin as a substitutive strategy against nosocomial pneumonia caused by CR-GNB in intensive care units: a retrospective cohort study

Jia-Yih Feng; Jhong-Ru Huang; Chang-Ching Lee; Yen-Han Tseng; Sheng-Wei Pan; Yuh-Min Chen; Kuang-Yao Yang

doi:10.1186/s13613-022-01088-4

Role of nebulized colistin as a substitutive strategy against nosocomial pneumonia caused by CR-GNB in intensive care units: a retrospective cohort study

Ann Intensive Care. 2023 Jan 7;13(1):1. doi: 10.1186/s13613-022-01088-4.

Authors

Jia-Yih Feng^{1

2}, Jhong-Ru Huang¹, Chang-Ching Lee¹, Yen-Han Tseng^{1

2}, Sheng-Wei Pan^#^{1

2

3}, Yuh-Min Chen^{1

2}, Kuang-Yao Yang^#^{4

5

6}

Affiliations

¹ Department of Chest Medicine, Taipei Veterans General Hospital, #201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan.
² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Department of Chest Medicine, Taipei Veterans General Hospital, #201, Sec. 2, Shih-Pai Road, Taipei, 11217, Taiwan. kyyang@vghtpe.gov.tw.
⁵ Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. kyyang@vghtpe.gov.tw.
⁶ Cancer Progression Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan. kyyang@vghtpe.gov.tw.

^# Contributed equally.

Abstract

Background: Adverse reactions, especially nephrotoxicity, are great concerns of intravenous colistin treatment. The role of substitutive nebulized colistin in treating nosocomial pneumonia caused by carbapenem-resistant Gram-negative bacterial (CR-GNB) in critically ill patients remains unknown.

Methods: This retrospective study enrolled patients with nosocomial pneumonia caused by colistin-susceptible CRGNB in the intensive care unit (ICU) without intravenous colistin treatment. Patients were categorized based on whether substitutive nebulized colistin was used alongside other intravenous antibiotics. Clinical responses and mortality rates were compared between the two groups in the original and propensity score (PS)-matched cohorts. This study aimed to investigate the clinical effectiveness of substitutive nebulized colistin in treatment outcomes of nosocomial pneumonia caused by CR-GNB. The impact of dosing strategy of nebulized colistin was also explored.

Results: In total, 343 and 214 patients with and without substitutive nebulized colistin, respectively, were enrolled for analysis. In the PS-matched cohort, clinical failure rates on day 7 (22.6 vs. 42.6%, p = 0.001), day 14 (27.0 vs. 42.6%, p = 0.013), and day 28 (27.8 vs. 41.7%, p = 0.027) were significantly lower in patients with nebulized colistin. In multivariate analysis, nebulized colistin was an independent factor associated with lower day 14 clinical failure (Original cohort: adjusted odds ratio (aOR) 0.45, 95% confidence interval (CI) 0.30-0.67; PS-matched cohort: aOR 0.48, 95% CI 0.27-0.87). There were no differences in clinical failure rate and mortality rate between patients receiving high (> 6 MIU/day) and low (≤ 6 MIU/day) dose nebulized colistin in the PS-matched cohort.

Conclusions: In ICU-admitted patients with nosocomial pneumonia caused by colistin-susceptible CRGNB, substitutive nebulized colistin was associated with better clinical outcomes.

Keywords: CR-GNB; Clinical failure; Colistin; Mortality; Nosocomial pneumonia.

Abstract

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