Multidisciplinary Intensive Care Unit Pierre Viars, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
Am J Respir Crit Care Med. 2011 Jul 1;184(1):106-15. doi: 10.1164/rccm.201011-1894OC. Epub 2011 Apr 7.
In experimental pneumonia, nebulization of antibiotics provides high lung tissue concentrations and rapid bacterial killing.
To assess the efficacy and safety of nebulized ceftazidime and amikacin in ventilator-associated pneumonia caused by Pseudomonas aeruginosa.
Forty patients with ventilator-associated pneumonia caused by Pseudomonas aeruginosa were included in a randomized comparative phase II trial. Twenty patients infected with susceptible or intermediate strains received nebulized ceftazidime (15 mg·kg(-1)·3 h(-1)) and amikacin (25 mg·kg(-1)·d(-1)). Seventeen patients infected with susceptible strains received intravenous ceftazidime (90 mg·kg(-1)·d(-1), continuous administration) and amikacin (15 mg·kg(-1)·d(-1)). In three patients infected with intermediate strains, amikacin was replaced by ciprofloxacin (400 mg·12 h(-1)).
After 8 days of antibiotic administration, aerosol and intravenous groups were similar in terms of successful treatment (70 vs. 55%), treatment failure (15 vs. 30%), and superinfection with other microorganisms (15 vs. 15%). Antibiotic-induced changes in lung aeration, determined by computed tomography, were not different between groups (increase in gas volume, 159 ± 460 vs. 251 ± 583 ml; decrease in tissue volume, -58 [-77, 25] vs. -89 [-139, 5] ml). Acquisition of per-treatment antibiotic resistance was observed exclusively in the intravenous group. In the aerosol group, four patients infected with intermediate strains were successfully treated. Nebulization induced an obstruction of the expiratory filter in three patients. The obstruction caused cardiac arrest in one patient, who fully recovered after brief cardiopulmonary resuscitation.
Nebulization and intravenous infusion of ceftazidime and amikacin provide similar efficiency for treating ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Nebulization is efficient against intermediate strains and may prevent per-treatment acquisition of antibiotic resistance.
在实验性肺炎中，抗生素雾化治疗可使肺部组织浓度高，杀菌迅速。
评估雾化头孢他啶和阿米卡星治疗铜绿假单胞菌呼吸机相关性肺炎的疗效和安全性。
40 例铜绿假单胞菌呼吸机相关性肺炎患者纳入一项随机对照的 II 期临床试验。20 例敏感或中介度菌株感染者接受雾化头孢他啶（15mg·kg-1·3h-1）和阿米卡星（25mg·kg-1·d-1）治疗。17 例敏感株感染者接受静脉头孢他啶（90mg·kg-1·d-1，持续滴注）和阿米卡星（15mg·kg-1·d-1）治疗。3 例中介度菌株感染者中，阿米卡星被环丙沙星（400mg·12h-1）取代。
抗生素治疗 8 天后，雾化组和静脉组的治疗成功率（70%比 55%）、治疗失败率（15%比 30%）和其他微生物继发感染率（15%比 15%）相似。两组患者的肺通气改变（由 CT 确定）无差异（气量增加，159±460ml 比 251±583ml；组织量减少，-58[-77，25]ml 比-89[-139，5]ml）。仅在静脉组观察到治疗中抗生素耐药性的获得。在雾化组中，4 例中介度菌株感染者得到成功治疗。3 例患者在雾化过程中出现呼气过滤器阻塞，其中 1 例阻塞导致心脏骤停，经短暂心肺复苏后完全恢复。
雾化和静脉滴注头孢他啶和阿米卡星治疗铜绿假单胞菌呼吸机相关性肺炎的疗效相似。雾化治疗对中介度菌株有效，并可预防治疗中抗生素耐药性的获得。
