Effectiveness of Adjunctive Inhaled Colistin in Treatment of Ventilator Associated Pneumonia

ABSTRACT

Ventilator-Associated pneumonia [VAP] represents a major health problem in mechanically ventilated patients in intensive care units [ICUs]. Aerosolized colistin could represent an adjunctive treatment to intravenous antibiotics in VAP. To evaluate the safety and efficacy of adjunctive inhaled colistin in treatment of patients with Gram-negative VAP compared to the conventional intravenous antibiotic regimen alone. This prospective r and omized controlled study was conducted from July 2013 to August 2014 at Kasr El-Aini Medical ICU. Our study included a total number of 50 cases with VAP r and omly assigned into two equal groups; a study group [who received the conventional systemic IV antibiotic regimen plus adjunctive inhaled colistin] and a control group [who received the conventional systemic IV antibiotic regimen alone]. 76% of the patients were men with severe underlying co-morbidities. The main causative organisms of VAP were Klebsiella spp. [32%], Acinetobacter spp. [26%] and Pseudomonas spp. [24%]. Patients in the study group had significantly more favourable microbiological outcome when compared with patients in the control group [80% versus 52%, P=0.03]. No adverse effects related to inhaled colistin [nephrotoxicity, neurotoxicity, bronchoconstriction, cough, apnea or chest tightness] were recorded. Inhaled colistin seems to be safe and efficient as an adjunctive treatment for patients with Gram-negative VAP