Nebulized colistin treatment of multi-resistant Acinetobacter baumannii pulmonary infection in critical ill patients
Utilización de la colistina nebulizada en la colonización e infección respiratoria por Acinetobacter baumannii en pacientes críticos
M.J. Pérez-Pedrero, M. Sánchez-Casado
, S. Rodríguez-Villar
Corresponding author
Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, Spain
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Olaechea, F. Álvarez-Lerma, M. Palomar, J. Insausti, M.J. López-Pueyo, A. Martínez-Pellús, M.L. Cantón" "autores" => array:8 [ 0 => array:2 [ "nombre" => "P.M." "apellidos" => "Olaechea" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Álvarez-Lerma" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Palomar" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Insausti" ] 4 => array:2 [ "nombre" => "M.J." "apellidos" => "López-Pueyo" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Martínez-Pellús" ] 6 => array:2 [ "nombre" => "M.L." "apellidos" => "Cantón" ] 7 => array:1 [ "colaborador" => "the ENVIN-HELICS Group" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572711700285?idApp=WMIE" "url" => "/21735727/0000003500000004/v1_201212101039/S2173572711700285/v1_201212101039/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "Nebulized colistin treatment of multi-resistant <span class="elsevierStyleItalic">Acinetobacter baumannii</span> pulmonary infection in critical ill patients" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "226" "paginaFinal" => "231" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.J. Pérez-Pedrero, M. Sánchez-Casado, S. Rodríguez-Villar" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.J." "apellidos" => "Pérez-Pedrero" ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Sánchez-Casado" "email" => array:1 [ 0 => "marcel55@terra.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Rodríguez-Villar" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Hospitalario de Toledo, Toledo, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilización de la colistina nebulizada en la colonización e infección respiratoria por <span class="elsevierStyleItalic">Acinetobacter baumannii</span> en pacientes críticos" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-10-14" "fechaAceptado" => "2011-01-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec10632" "palabras" => array:4 [ 0 => "Colistin" 1 => "Nebulized colistin" 2 => "Multi-resistant germs" 3 => "<span class="elsevierStyleItalic">Acinetobacter baumannii</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec10633" "palabras" => array:4 [ 0 => "Colistina" 1 => "Colistina nebulizada" 2 => "Microorganismos multirresistentes" 3 => "<span class="elsevierStyleItalic">Acinetobacter baumannii</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze the efficacy of nebulized colistin in the microbiological eradication and clinical improvement of patients with pulmonary infection by multi-resistant <span class="elsevierStyleItalic">Acinetobacter baumannii</span> (MAB).</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study.</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Intensive Care Unit of a Tertiary hospital.</p> <span class="elsevierStyleSectionTitle">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Hospitalized patients on invasive mechanical ventilation with positive MAB cultures of the airway.</p> <span class="elsevierStyleSectionTitle">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">All received treatment with colistin (CL). Nosocomial pneumonia (NP) or Tracheobronchitis (TB) was determined according to routine criteria and colonization (CO) was determined in the case of a positive culture in the absence of infection criteria. Three groups of patients were defined: those treated with nebulized CL, those treated with IV CL and those treated with IV CL plus nebulized CL.</p> <span class="elsevierStyleSectionTitle">Main measurements</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics. Microbiological eradication and clinical recovery were evaluated according to routine criteria.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">83 patients were studied, 54 of whom were treated, with the following diagnoses: 15 (27.8%) with NP, 16 (29.6%) with TB and 23 patients (42.6%) with CO. Nebulized CL was used in 36 patients (66.7%): 66.7% of which for CO, 33.3% in treatment for TB and in no case of NP. In 61.1% of the patients, IV CL was used: 22.2% of which for CO, 38.9% for TB and 38.9% in NP. The combination of IV CL and nebulized CL was used in 15 patients (27.8%): 5 patients (33.3%) CO, 2 patients (13.3%) TB and 8 patients (53.3%) NP. Microbiological eradication was achieved in 32 patients (59.3%), with the following distribution: 8 (47.1%) with IV CL, 15 (83.3%) with nebulized CL and 9 patients (69.2%) with a combination of IV CL and nebulized CL. Clinical recovery was achieved in 42 patients (77.8%): 12 (80%) with IV CL, 18 (94.7%) with nebulized CL and 12 (85.7%) with a combination of nebulized and IV CL. These differences were not significant. In the group of patients with infection due to TB and NP (31 patients, 57.4%), microbiological eradication was achieved in 5 patients (100%) treated with nebulized CL and in 6 of the 9 patients (42.9%) treated with IV CL, the difference being significant (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05). Clinical recovery in this group was 100% (6 patients) treated with nebulized CL and 75% (9 of the 12 patients) in the IV CL group. This difference was not significant.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our study suggests that treatment with colistin in patients with pulmonary infection with multi-resistant <span class="elsevierStyleItalic">Acinetobacter baumannii</span> could be more efficient if it were to be administrated solely nebulized or in combination with IV colistin rather than administered solely intravenously.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evaluar la eficacia de la colistina nebulizada en la erradicación microbiológica y la mejoría clínica de pacientes con Acinetobacter baumannii en vías respiratorias.</p> <span class="elsevierStyleSectionTitle">Diseño</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo.</p> <span class="elsevierStyleSectionTitle">Ámbito</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Servicio de medicina intensiva en hospital terciario.</p> <span class="elsevierStyleSectionTitle">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Pacientes ingresados en ventilación mecánica invasiva con cultivos positivos en vía aérea para <span class="elsevierStyleItalic">A. baumannii</span> multirresistente.</p> <span class="elsevierStyleSectionTitle">Intervenciones</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Todos recibieron tratamiento con colistina (CL). Se determinó neumonía nosocomial (NN) o traqueobronquitis (TB) según criterios habituales y colonización (CO) si había cultivo positivo en ausencia de criterios de infección. Se definieron 3 grupos de pacientes: tratados con CL nebulizada, con CL i.v. y con CL i.v. más nebulizada.</p> <span class="elsevierStyleSectionTitle">Variables de interés</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Características basales. Se consideró erradicación microbiológica y curación clínica según criterios habituales.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se estudió a 83 pacientes; 54 fueron tratados, con los diagnósticos: 15 (27,8%) con NN, 16 (29,6%) con TB y 23 pacientes (42,6%) con CO. La CL nebulizada fue utilizada en 36 pacientes (66,7%): en el 66,7% en CO, el 33,3% en tratamiento de TB y en ningún caso de NN. En el 61,1% de los pacientes se utilizó CL i.v.: en la CO en el 22,2%, en la TB en el 38,9% y en las NN en el 38,9%. La combinación de CL i.v. más nebulizada fue utilizada en 15 pacientes (27,8%), que se empleó: 5 (33,3%) CO, 2 (13,3%) TB y 8 (53,3%) NN. La erradicación microbiológica se consiguió en 32 pacientes (59,3%), con la distribución: 8 (47,1%) con CL i.v., 15 (83,3%) con CL nebulizadas y 9 pacientes (69,2%) con la combinación CL i.v. más nebulizada. La curación clínica se consigue en 42 pacientes (77,8%): 12 (80%) con CL i.v., 18 (94,7%) con CL nebulizada y 12 (85,7%) con la combinación de CL nebulizada e intravenosa. Estas diferencias no fueron significativas. En el grupo de pacientes con infección por TB y NN (31 pacientes, 57,4%) la erradicación microbiológica se consiguió en 5 pacientes (100%) tratados con CL nebulizada y en 6 de 14 (42,9%) tratados con CL i.v.; esta diferencia fue significativa (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,05). La curación clínica en este grupo fue del 100% (6 pacientes) tratados con CL nebulizada y del 75% (9 de 12) en el grupo de CL i.v. Esta diferencia no fue significativa.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio señala que el tratamiento con colistina en pacientes con infección pulmonar por A. baumannii multirresistente podría ser más eficaz si se administra nebulizada o en combinación con colistina i.v. que si se administra de forma intravenosa solamente.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiresistant Acinetobacter baumannii infections: epidemiology and management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Garnacho-Montero" 1 => "R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 14 | 22 |
| 2024 October | 42 | 75 | 117 |
| 2024 September | 51 | 52 | 103 |
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| 2024 May | 45 | 46 | 91 |
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| 2023 September | 31 | 46 | 77 |
| 2023 August | 18 | 22 | 40 |
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| 2023 June | 25 | 15 | 40 |
| 2023 May | 11 | 10 | 21 |
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