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Published on: January 17, 2025
Pilot Study of Aerosolised Plus Intravenous Vancomycin in Mechanically Ventilated Patients with Methicillin-Resistant
Jun Yeun Cho1, Hyung-Sook Kim2, Hye-Joo Yang3
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju-si 28644, Korea.
Abstract:
Treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in critically ill patients remains unsatisfactory. This pilot study aimed to evaluate the clinical outcomes of aerosolised vancomycin in addition to intravenous administration in this setting. This was a prospective, noncomparative, phase II trial. Patients receiving mechanical ventilation for >48 h in intensive care units (ICUs) were screened; those receiving intravenous vancomycin for MRSA pneumonia were enrolled. Patients received aerosolised vancomycin (250 mg every 12 h for five days) via a vibrating mesh nebuliser. The primary outcome was treatment success (clinical cure or improvement) at the conclusion of antibiotic treatment. Vancomycin concentrations were measured in bronchoalveolar lavage fluid according to administration time. Twenty patients were enrolled (median age 75 years and 13 (65%) men; 18 (90%) cases with nosocomial pneumonia). Thirteen patients (65%) showed clinical cure or improvement. Microbiological eradication of MRSA was confirmed in 14 patients (70%). ICU and hospital mortality rates were 30% and 35%, respectively. Maximum aerosolised vancomycin concentration was observed 4-5 h after nebulising (98.75 ± 21.79 mcg/mL). No additional systemic adverse effects occurred following aerosol vancomycin treatment. Aerosolised vancomycin combination therapy may be an alternative treatment for patients with severe MRSA pneumonia receiving mechanical ventilation (ClinicalTrials.gov number, NCT01925066).
Insights
Aerosolized vancomycin combined with IV therapy shows promise for treating severe methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in ventilated patients. This approach achieved clinical improvement in 65% of patients with no additional adverse effects.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonary Medicine
Background:
- Treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in critically ill patients presents significant challenges.
- Existing intravenous vancomycin regimens may have suboptimal outcomes in severe cases, necessitating alternative strategies.
- Mechanical ventilation further complicates MRSA pneumonia management, increasing the need for effective therapies.
Purpose of the Study:
- To evaluate the clinical outcomes of adding aerosolized vancomycin to standard intravenous vancomycin for MRSA pneumonia.
- To assess the safety and efficacy of this combination therapy in mechanically ventilated, critically ill patients.
- To determine vancomycin concentrations in bronchoalveolar lavage fluid following aerosolized administration.
Main Methods:
- A prospective, noncomparative, phase II pilot study.
- Enrolled 20 mechanically ventilated patients with MRSA pneumonia receiving intravenous vancomycin.
- Administered aerosolized vancomycin (250 mg every 12 hours for five days) via a vibrating mesh nebulizer.
Main Results:
- Treatment success (clinical cure or improvement) was observed in 13 patients (65%).
- Microbiological eradication of MRSA was achieved in 14 patients (70%).
- No additional systemic adverse effects were noted; ICU and hospital mortality rates were 30% and 35%, respectively.
Conclusions:
- Combination therapy with aerosolized and intravenous vancomycin appears to be a viable alternative for severe MRSA pneumonia in mechanically ventilated patients.
- The treatment demonstrated acceptable clinical outcomes and microbiological eradication.
- Further comparative studies are warranted to confirm the benefits of this therapeutic approach.
