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Randomized control study of nebulized colistin as an adjunctive therapy in ventilator-associated pneumonia in
K S Bharathi1, Ananda Bhat2, Gegal Pruthi2
1Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India.
Insights
Nebulized colistin (NC) combined with intravenous antibiotics significantly reduced mechanical ventilation duration and hospital stays in pediatric patients with ventilator-associated pneumonia (VAP). This adjunctive therapy offers a promising approach for treating VAP caused by gram-negative bacteria.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pediatric Pulmonology
Background:
- Ventilator-associated pneumonia (VAP) is a significant challenge in intensive care units (ICUs), often caused by multidrug-resistant (MDR) gram-negative organisms.
- Aerosolized antibiotics are explored as adjunctive therapies to systemic antibiotics to improve treatment efficacy.
Purpose of the Study:
- To compare clinical and bacteriological outcomes of VAP patients treated with intravenous antibiotics alone versus intravenous antibiotics plus nebulized colistin (NC).
- To assess the safety and occurrence of adverse events associated with nebulized colistin therapy.
Main Methods:
- A prospective, randomized, double-blinded controlled study involving 98 pediatric patients (<12 years) with VAP due to gram-negative bacteria after cardiac surgery.
- Patients were randomized to receive either systemic antibiotics with NC or systemic antibiotics with nebulized normal saline (NS).
- Clinical and bacteriological outcomes were assessed, and statistical analysis was performed using SPSS.
Main Results:
- The NC group showed a statistically significant reduction in the duration of mechanical ventilation compared to the NS group (P < 0.05).
- Patients receiving NC also experienced significantly shorter postoperative ICU and hospital stays.
- No significant adverse events were reported during colistin nebulization.
Conclusions:
- Adjunctive nebulized colistin is effective in improving clinical outcomes for pediatric VAP patients with gram-negative bacterial infections susceptible to colistin.
- Nebulized colistin can be considered a valuable addition to standard intravenous antibiotic treatment for VAP in this population.
Background:
Ventilator-associated pneumonia (VAP) with multidrug-resistant (MDR) gram negative organisms is a common problem in intensive care unit (ICU). Aerosolized antibiotics enhance the efficacy of systemic antibiotics when added as adjuvants.
Aim:
The primary objective of the study was to compare the clinical and bacteriological outcome of patients with VAP who were administered intravenous (IV) antibiotics alone with those patients who were treated with adjunctive nebulized colistin (NC) along with IV antibiotics. The secondary objective was to study the occurrence of any adverse events during colistin nebulization.
Settings And Design:
The study was a prospective, randomized, double-blinded controlled study conducted at a tertiary-care teaching institution.
Materials And Methods:
Ninety-eight children from surgical ICU aged less than 12 years who were diagnosed with VAP due to gram negative bacteria following cardiac surgery were chosen and divided randomly into two groups. The experimental group (NC group) was treated with systemic antibiotics along with NC, whereas the control group (NS group) was administered systemic antibiotics with nebulized normal saline (NS). Clinical and bacteriological outcomes were noted. Statistical analysis was done using SPSS Version 20.0 software. The patient characteristics were compared using independent Student's t test and Chi-square test.
Results:
There was a statistically significant reduction in the duration of mechanical ventilation, postoperative ICU and hospital stay (P < 0.05) in the NC group compared with the NS group.
Conclusion:
Aerosolized colistin may be considered as an adjunct to systemic IV antibiotics in pediatric patients with VAP due to gram negative bacteria susceptible to colistin.
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