Almangour Thamer A, Alenazi Basel, Ghonem Leen, Alhifany Abdullah A, Aldakheel Bassam A, Alruwaili Alya
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia.
College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh 11451, Saudi Arabia.
Saudi Pharm J. 2020 Aug;28(8):1009-1013. doi: 10.1016/j.jsps.2020.06.023. Epub 2020 Jul 3.
Nosocomial pneumonia (NP) due to multidrug-resistant (MDR) Gram-negative pathogens, has continued to rise over the last several decades. Parenteral administration of colistin results in poor alveolar penetration and subtherapeutic concentration; therefore, direct drug deposition at site of infection may improve the effectiveness while minimizing the systemic exposure. The aim of this study is to describe the safety and effectiveness of inhaled colistin for the treatment of NP caused by MDR Gram-negative pathogens.
Patients who received inhaled colistin from May 2015 to May 2019 at 2 different tertiary care hospitals in Riyadh, Saudi Arabia were identified from pharmacy databases and their charts were retrospectively reviewed.
86 patients were enrolled in this study. The mean age was 56 ± 20 years. The mean Acute Physiology and Chronic Health Evaluation (APACHE II) was 17 ± 5. The responsible pathogens for NP were (60%) (28%), and (9%). Most patients (76/86) received concomitant intravenous antibiotics. Mean colistin total daily dose was 6 ± 3 million international units divided into 2-3 doses. Mean inhaled colistin duration of therapy was 11 ± 6 days. Favorable clinical outcome was achieved in 51 (59%) patients while favorable microbiological outcome occurred in 29 (34%) patients. Death due to all causes was noted in 39 (45%) cases. Renal injury occurred in 19 (22%) patients, all received concomitant intravenous colistin.
Inhaled colistin can be considered as salvage therapy as adjunct to intravenous administration for treatment of patients with NP due to MDR Gram-negative pathogens.
在过去几十年中，由多重耐药（MDR）革兰氏阴性病原体引起的医院获得性肺炎（NP）持续增加。静脉注射多黏菌素导致肺泡穿透性差且药物浓度低于治疗水平；因此，将药物直接沉积在感染部位可能会提高疗效，同时将全身暴露降至最低。本研究的目的是描述吸入多黏菌素治疗由MDR革兰氏阴性病原体引起的NP的安全性和有效性。
从沙特阿拉伯利雅得的2家不同的三级护理医院的药房数据库中识别出2015年5月至2019年5月期间接受吸入多黏菌素治疗的患者，并对其病历进行回顾性审查。
本研究共纳入86例患者。平均年龄为56±20岁。急性生理与慢性健康状况评价系统（APACHE II）平均评分为17±5。引起NP的主要病原体为（60%）、（28%）和（9%）。大多数患者（76/86）同时接受静脉抗生素治疗。多黏菌素平均每日总剂量为6±3百万国际单位，分2至3次给药。吸入多黏菌素的平均治疗持续时间为11±6天。51例（59%）患者获得了良好的临床结局，29例（34%）患者获得了良好的微生物学结局。39例（45%）患者出现各种原因导致的死亡。19例（22%）患者发生肾损伤，所有患者均同时接受了静脉注射多黏菌素治疗。
吸入多黏菌素可作为静脉给药的辅助挽救疗法，用于治疗由MDR革兰氏阴性病原体引起的NP患者。
