Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Intensive Care Medicine, Campus Benjamin Franklin, Berlin, Germany.
Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Lübeck, Germany.
Anaesth Crit Care Pain Med. 2023 Oct;42(5):101249. doi: 10.1016/j.accpm.2023.101249. Epub 2023 May 20.
Treatment of ventilated pneumonia is often unsuccessful, even when patients are treated according to current guidelines. Therefore, we aimed to investigate the efficacy of the adjunctive inhaled Tobramycin in patients with pneumonia caused by Gram-negative pathogens in addition to the standard systemic treatment.
Prospective, multicenter, double-blinded, randomized, placebo-controlled clinical trial.
26 patients in medical and surgical ICUs.
Patients with ventilator-associated pneumonia caused by Gram-negative pathogens.
Fourteen patients were assigned to the Tobramycin Inhal group and 12 patients to the control group. The microbiological eradication of the Gram-negative pathogens was significantly higher in the intervention group than in the control group (p < 0.001). The probability of eradication was 100% in the intervention group [95% Confidence Interval: 0.78-1.0] and 25% in the control group [95% CI: 0.09-0.53]. The increased eradication frequency was not associated with increased patient survival.
Inhaled aerosolized Tobramycin demonstrated clinically meaningful efficacy in patients with Gram-negative ventilator-associated pneumonia. The probability of eradication in the intervention group was 100%. However, the successful eradication was not associated with a reduction in systemic anti-infective therapy, a shorter ICU stay, or even a survival benefit. In the presence of multidrug-resistant Gram-negative pathogens that are sensitive only to colistin and/or aminoglycosides, supplemental inhaled therapy with nebulizers suitable for this purpose should be considered in addition to systemic antibiotic therapy.
即使患者按照当前指南进行治疗，通气相关性肺炎的治疗也常常不成功。因此，我们旨在研究附加吸入妥布霉素对革兰氏阴性病原体引起的肺炎患者的疗效，除了标准的全身治疗之外。
前瞻性、多中心、双盲、随机、安慰剂对照临床试验。
26 名患者在医疗和外科重症监护病房。
由革兰氏阴性病原体引起的呼吸机相关性肺炎患者。
14 名患者被分配到妥布霉素吸入组，12 名患者被分配到对照组。干预组革兰氏阴性病原体的微生物消除率明显高于对照组（p < 0.001）。干预组的根除率为 100% [95%置信区间：0.78-1.0]，对照组为 25% [95%CI：0.09-0.53]。根除频率的增加与患者存活率的增加无关。
吸入性妥布霉素气雾剂在革兰氏阴性呼吸机相关性肺炎患者中具有明显的临床疗效。干预组的根除率为 100%。然而，成功的根除与减少全身抗感染治疗、缩短 ICU 住院时间甚至生存获益无关。在存在仅对粘菌素和/或氨基糖苷类敏感的多药耐药革兰氏阴性病原体的情况下，除了全身抗生素治疗外，还应考虑使用适合此目的的雾化器进行补充吸入治疗。
