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Published on: July 2, 2013

Aerosol polymyxin and pneumonia in seriously ill patients

T W Feeley, G C Du Moulin, J Hedley-Whyte

    The New England Journal of Medicine
    |September 4, 1975
    PubMed

    Insights

    Continuous polymyxin B aerosol therapy for critically ill patients did not prevent Pseudomonas aeruginosa pneumonia but led to resistant organisms and high mortality. This therapy is considered dangerous.

    Area of Science:

    • Critical Care Medicine
    • Infectious Diseases
    • Pharmacology

    Background:

    • Pseudomonas aeruginosa pneumonia is a severe complication in critically ill patients, carrying a high mortality rate.
    • Preventing ventilator-associated pneumonia (VAP) caused by multidrug-resistant organisms is a significant challenge in intensive care units.

    Purpose of the Study:

    • To evaluate the efficacy of aerosolized polymyxin B in preventing Pseudomonas aeruginosa pneumonia in a respiratory-surgical intensive care unit.
    • To assess the safety and impact of polymyxin B aerosol on the development of resistant pathogens.

    Main Methods:

    • A prospective study involving 292 critically ill patients in a respiratory-surgical ICU over seven months.
    • Administration of aerosolized polymyxin B (2.5 mg/kg/day) to the upper airways of patients.
    • Monitoring for the development of pneumonia, causative organisms, and patient mortality.

    Main Results:

    • Only one case of Pseudomonas aeruginosa pneumonia occurred, suggesting prevention of this specific pathogen.
    • Ten patients developed pneumonia caused by polymyxin-resistant organisms.
    • Seven pneumonias were attributed to less common pathogens, including flavobacteria, serratia, and Streptococcus faecalis.
    • The overall mortality rate for hospital-acquired pneumonia in the study group was 64%.

    Conclusions:

    • Continuous aerosolized polymyxin B is ineffective in preventing Pseudomonas aeruginosa pneumonia and may promote the emergence of resistant organisms.
    • The use of polymyxin B aerosol in this context was associated with a high mortality rate, exceeding that of previous studies.
    • Continuous polymyxin B aerosol therapy is considered a dangerous intervention in critically ill patients.

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