Background: Infections caused by multidrug-resistant (MDR) pathogen have caused a resurgence of interest in colistin. To date, information about the effectiveness of Aerosolized Colistin (AS) is very limited in the treatment of Ventilator-Associated Pneumonia (VAP).
Aim: to compare between safety and efficacy of intravenous colistin versus aerosolized colistin in treatment of VAP due to MDR gram negative bacteria (acinetobacter MDRA) as regard the effect on outcome of patients, clinical improvement, length of stay on mechanical ventilation and mortality.
Subjects and Methods: The study included sixty adult patients after ≥48 hours of mechanical ventilation. Patients were assigned randomly into two equal groups: group (A) including 30 patients who received a daily dose of nebulized colistin colistimethate sodium (CMS). Group (B): including 30 patients received intravenous colistin.
Results: The two groups showed a non-significant difference as regards age, and sex. There was no statistically significant difference found between both groups regarding the parameters of CPIS score, APACHE II score and SOFA score (P > 0.05). There was no statistical significance in the mechanical ventilation days, ICU stay, clinical cure and clinical improvement between both groups (P = 0.138, 0.053, 0.058 and 0.166 respectively). There was statistically significant increase in nephrotoxicity in intravenous group than nebulized group (P = 0.020) and a significant decrease in the rate of microbial eradication in intravenous colistin than nebulized colistin (P = 0.002)
Conclusion: The current study suggested that the use of inhaled colistin seems to be beneficial in therapy of MDR bacilli VAP. Further, it provided several benefits: a renal safety and a better bacterial eradication. We suggest the regimen of high dose ampicillin–sulbactam plus nebulized colistin regimen has comparable efficacy with intravenous colistin in treatment of VAP caused by MDR Acinetobacter Baumannii with sensitivity to colistin only, with probably lower incidence of kidney injury, based on AKIN criteria, and could be considered as an alternative treatment aerosolized colistin as the first-line therapy in VAP due to MDR bacilli outside a septic shock and/or bacteremia.
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