Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, 38039 Kayseri, Turkey.
J Infect Chemother. 2012 Dec;18(6):872-7. doi: 10.1007/s10156-012-0430-7. Epub 2012 May 29.
In this study we aimed to assess the safety and efficacy of high-dose IV colistin (COL) and aerosolized COL for the treatment of Acinetobacter baumannii ventilator-associated pneumonia (VAP). Critically ill adult patients who received IV COL for multidrug-resistant A. baumannii VAP were evaluated retrospectively. A total of 45 patients were evaluated [15 patients with high-dose COL (2.5 mg/kg every 6 h), 20 patients with normal dose (2.5 mg/kg every 12 h), and 10 patients with low dose, determined according to creatine clearance]. Aerosolized COL was used in 29 patients treated with parenteral COL and 16 patients received only parenteral COL. The clinical response rates on the fifth day were 50, 30, and 27 % with the normal, low, and high doses, respectively. However, the clinical response rates at the end of the therapy had declined to 30, 30, and 7 % with the normal, low, and high doses, respectively. The bacteriological clearance rates at the end of the therapy were 65, 75, and 64 %, with the normal, low, and high doses, respectively. With the aerosolized COL, the clinical response rates on the fifth day and at the end of the therapy were 35 and 14 %, whereas these rates were 44 and 38 % without the aerosolized COL. Bacteriological clearance rates with and without the aerosolized COL were 76 and 69 %, respectively. The nephrotoxicity rate was 40 % for the high-dose COL, whereas it was 35 % for the normal dose, and 20 % for the low-dose COL. In conclusion, higher doses of COL and aerosolized COL had no advantages over lower doses in alleviating multidrug-resistant A. baumannii VAP. Moreover, the higher doses and the aerosolized COL increased the nephrotoxicity risk and seemed not to be safe.
在这项研究中，我们旨在评估高剂量静脉注射黏菌素（COL）和雾化 COL 治疗鲍曼不动杆菌呼吸机相关性肺炎（VAP）的安全性和疗效。回顾性评估了接受静脉注射 COL 治疗多重耐药鲍曼不动杆菌 VAP 的危重症成年患者。共评估了 45 例患者[15 例患者接受高剂量 COL（2.5mg/kg，每 6 小时 1 次），20 例患者接受常规剂量（2.5mg/kg，每 12 小时 1 次），10 例患者根据肌酐清除率确定低剂量]。29 例接受静脉注射 COL 治疗的患者使用了雾化 COL，16 例患者仅接受了静脉注射 COL。第 5 天的临床反应率分别为高剂量、低剂量和常规剂量的 50%、30%和 27%。然而，治疗结束时的临床反应率分别下降至高剂量、低剂量和常规剂量的 30%、30%和 7%。治疗结束时的细菌清除率分别为高剂量、低剂量和常规剂量的 65%、75%和 64%。使用雾化 COL 时，第 5 天和治疗结束时的临床反应率分别为 35%和 14%，而不使用雾化 COL 时，这些比率分别为 44%和 38%。使用和不使用雾化 COL 的细菌清除率分别为 76%和 69%。高剂量 COL 的肾毒性发生率为 40%，常规剂量为 35%，低剂量为 20%。总之，与低剂量相比，高剂量 COL 和雾化 COL 并不能缓解多重耐药鲍曼不动杆菌 VAP。此外，高剂量和雾化 COL 增加了肾毒性风险，似乎不安全。
