다제내성 Acinetobacter baumannii 또는 Pseudomonas aeruginosa에 의한 폐렴에서 Colistin 정맥주입과 분무요법의 치료 효과 및 안전성 비교
Comparative Evaluation of Intravenous vs. Nebulized Colistin Treatment of Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii & Pseudomonas aeruginosa
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Background : Multidrug resistant (MDR) Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) have emerged as major pathogens of pneumonia in the intensive care unit (ICU). Colistin is used as a drug of choice against pneumonia caused by these pathogens, but when it is administrated systemically, adverse effects such as renal toxicity and neurotoxicity limit its application. Recently, nebulized treatment of colistin has been widely applied to reduce these adverse effects, but the clinical data of nebulized colistin has been limited. The purpose of this study was to compare the efficacy and safety of nebulized colistin with intravenous colistin. Methods : A retrospective medical records review was conducted on patients admitted to the ICUs at a teaching hospital. The patients were diagnosed with pneumonia caused by MDR A. baumanniior P. aeruginosa and treated with colistin either by intravascular or nebulized form August 2015-July 2016. Results : This study included 88 patients, of whom 29 received intravenous colisitin (IV group), and 59 nebulized colistin (Neb group). The mean duration of treatment was 14.8 days in the IV group and 15.8 days in the Neb group (p=0.604). The success rate of treatment based on clinical response and negative conversion rate were not different between the two groups (58.6% vs. 54.2%, OR 0.84, 95% CI 0.34-2.06, p=0.697, respectively). The number of patients whose white blood cell count recovered to normal range during or after colistin treatment was significantly larger in the Neb group than the IV group (55.9% vs. 41.4%, OR 3.77, 95% CI 1.55-9.15, P=0.003, respectively). The negative conversion rate was not different between the two groups (41.4% vs. 37.3%, OR 0.84, 95% CI 0.34- 2.09, p=0.711, respectively). The serum creatinine difference before and after the colistin treatment was significantly greater in the IV group than in the Neb group (0.48±0.17 vs. 0.01±0.11, p=0.016). The acute kidney injury (AKI) incidence rate was also significantly higher in the IV group than the Neb group (62.1% vs. 23.7%, p<0.001, respectively). Conclusion : The efficacy of nebulized colistin was similar with intravenous colistin for ICU patients with pneumonia caused by MDR A. baumannii or P. aeruginosa. Also, nebulized colistin showed favorable results in serum creatinine change and the AKI incidence rate.
Abstract
Background : Multidrug resistant (MDR) Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) have emerged as major pathogens of pneumonia in the intensive care unit (ICU). Colistin is used as a drug of choice against pneumonia caused by these pathogens, but when it is administrated systemically, adverse effects such as renal toxicity and neurotoxicity limit its application. Recently, nebulized treatment of colistin has been widely applied to reduce these adverse effects, but the clinical data of nebulized colistin has been limited. The purpose of this study was to compare the efficacy and safety of nebulized colistin with intravenous colistin. Methods : A retrospective medical records review was conducted on patients admitted to the ICUs at a teaching hospital. The patients were diagnosed with pneumonia caused by MDR A. baumanniior P. aeruginosa and treated with colistin either by intravascular or nebulized form August 2015-July 2016. Results : This study included 88 patients, of whom 29 received intravenous colisitin (IV group), and 59 nebulized colistin (Neb group). The mean duration of treatment was 14.8 days in the IV group and 15.8 days in the Neb group (p=0.604). The success rate of treatment based on clinical response and negative conversion rate were not different between the two groups (58.6% vs. 54.2%, OR 0.84, 95% CI 0.34-2.06, p=0.697, respectively). The number of patients whose white blood cell count recovered to normal range during or after colistin treatment was significantly larger in the Neb group than the IV group (55.9% vs. 41.4%, OR 3.77, 95% CI 1.55-9.15, P=0.003, respectively). The negative conversion rate was not different between the two groups (41.4% vs. 37.3%, OR 0.84, 95% CI 0.34- 2.09, p=0.711, respectively). The serum creatinine difference before and after the colistin treatment was significantly greater in the IV group than in the Neb group (0.48±0.17 vs. 0.01±0.11, p=0.016). The acute kidney injury (AKI) incidence rate was also significantly higher in the IV group than the Neb group (62.1% vs. 23.7%, p<0.001, respectively). Conclusion : The efficacy of nebulized colistin was similar with intravenous colistin for ICU patients with pneumonia caused by MDR A. baumannii or P. aeruginosa. Also, nebulized colistin showed favorable results in serum creatinine change and the AKI incidence rate.
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