Efficacy and toxicity of high-dose nebulized colistin for critically ill surgical patients with ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii

Purpose: Few studies have compared nebulized and intravenous (IV) colistin for multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa pneumonia. This study compared the nephrotoxicity and clinical outcomes for these two delivery routes. Methods: This study retrospectively compared 95 critically ill surgical patients who were diagnosed with Acinetobacter baumannii ventilator associated pneumonia and received colistin between March 2013 and January 2016. Results: The most common diagnoses were brain hemorrhage (27.4%), traumatic brain injury (20%), traumatic thoracic injury (15.8%), and secondary peritonitis (11.6%). Compared to the IV group, the nebulizer group was significantly older (60.0 vs. 67.5 years, p = 0.010), had higher APACHE II scores (16.3 vs. 19.9, p = 0.001), and more frequently had diabetes mellitus (6.8% vs. 21.6%, p = 0.043). Nephrotoxicity was more common in the IV group (60.5% vs. 15.7%, p < 0.0001). Both groups had similar microbiological and clinical outcomes (p = 0.921 and p= 0.719, respectively). Patients with nephrotoxicity exhibited prolonged IV or nebulized colistin treatment and more frequent combination with vancomycin. Nephrotoxicity was independently associated with IV delivery (odds ratio: 8.48, 95% confidence interval: 2.95-24.39, p < 0.0001). Conclusions: Nebulized colistinmay have less nephrotoxicity and provide similar clinical results, compared to IV colistin. (C) 2017 Elsevier Inc. All rights reserved.