Use of High-Dose Nebulized Colistimethate in Patients with Colistin-Only Susceptible Acinetobacter baumannii VAP: Clinical, Pharmacokinetic and Microbiome Features
Abstract
:1. Introduction
2. Methods
2.1. Study Setting and Design
2.2. Definitions and Outcomes
2.3. Pharmacokinetic Analysis
2.4. Microbiological Analysis
2.5. Statistical Analysis
3. Results
3.1. Population Characteristics and Treatment
3.2. Clinical Outcomes and Microbiological Findings
3.3. Pharmacokinetic Findings
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Baseline Characteristics | |
Age | 66 [58–73] |
Gender (male) | 103 (76.9) |
SAPS II | 42 [32–57] |
Hypertension | 91 (67.9) |
IHD | 22 (16.4) |
CHD | 5 (3.7) |
COPD | 23 (17.2) |
Cerebral Vasculopathy | 11 (8.2) |
Diabetes | 30 (22.4) |
CKD | 14 (10.4) |
Immunosuppression | 10 (7.5) |
VAP Presenting Features | |
Pre-VAP Hospital LOS (days) | 16 [12.5–24] |
pre-VAP ICU LOS (days) | 13 [8–18] |
pre-VAP MV (days) | 9 [6–15] |
PaO2/FiO2 | 120 [100–164] |
Septic Shock | 53 (40.3) |
AKI requiring CRRT | 18 (14.2) |
BSI | 33 (24.6) |
MIC * mcg/mL | 1 [0.5–1] |
Aerosol Colistin days | 10 [5–13] |
Intravenous Colistin days | 8 [3–11] |
Outcome measures | |
28-day mortality | 68 (50.7) |
90-day mortality | 78 (58.2) |
Clinical cure | 81 (60.4) |
Microbiological eradication | 54 (40.3) |
Post-VAP Hospital LOS (days) | 21 [10–46.5] |
Post-VAP ICU LOS (days) | 15 [9–27.75] |
Post-VAP MV (days) | 12 [7.25–19] |
Aerosol adverse events | 0 (0) |
Variables | No. % of Patients | Univariate Analysis | Adjusted Analysis | |||
---|---|---|---|---|---|---|
AB Eradication (n = 55) | AB Persistence (n = 79) | p Value | OR (95%CI) | p Value | OR (95%CI) | |
Demographics and comorbidities | ||||||
Age | 61 [52.5–67.25] | 69 [60–74.25] | 0.002 | 0.949 (0.918–0.981) | 0.127 | 0.972 (0.936–1.008) |
Gender (male) | 42 (76.36) | 61(77.22) | 0.752 | 0.864 (0.35–2.136) | - | - |
SAPS II | 37.5 [25.5–50.25] | 45 [35–62] | <0.001 | 0.961 (0.939–0.984) | 0.002 | 0.963 (0.940–0.986) |
Hypertension | 35 (63.6) | 56 (70.88) | 0.377 | 0.719 (0.345–1.496) | - | - |
IHD | 6 (10.91) | 16 (20.25) | 0.157 | 0.482 (0.176–1.324) | - | - |
CHD | 1 (1.81) | 4 (5.06) | 0.35 | 0.347 (0.038–3.194) | - | - |
COPD | 9 (16.36) | 14 (17.72) | 0.838 | 0.908 (0.363–2.276) | - | - |
Cerebral Vasculopathy | 4 (7.27) | 7 (8.86) | 0.742 | 0.807 (0.224–2.901) | - | - |
Diabetes | 12 (21.82) | 18 (22.78) | 0.895 | 0.946 (0.413–2.165) | - | - |
CKD | 8 (14.55) | 6 (7.59) | 0.203 | 2.071 (0.676–6.348) | - | - |
Immunosuppression | 3 (5.45) | 7 (8.86) | 0.465 | 0.593 (0.147–2.403) | - | - |
VAP Presenting Features and Treatment | ||||||
PaO2/FiO2 | 131.5 [108.5–180] | 114.5 [90–151] | 0.006 | 1.009 (1.003–1.016) | 0.034 | 1.008 (1.001–1.015) |
Septic Shock | 17 (30.91) | 36 (45.57) | 0.089 | 0.534 (0.259–1.101) | 0.919 | 0.956 (0.401–2.277) |
CRRT | 6 (10.91) | 12 (15.19) | 0.466 | 0.677 (0.237–1.932) | - | - |
Concomitant BSI | 14 (25.45) | 19 (24.05) | 0.919 | 1.042 (0.469–2.315) | - | - |
Nebulized Colistin days | 12 [9.75–14] | 7 [4–13] | 0.012 | 1.075 (1.016–1.137) | 0.039 | 1.069 (1.003–1.138) |
Intravenous Colistin days | 10 [6–12] | 6 [2.75–10] | 0.057 | 1.065 (0.998–1.137) | 0.756 | 1.014 (0.928–1.109) |
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De Pascale, G.; Pintaudi, G.; Lisi, L.; De Maio, F.; Cutuli, S.L.; Tanzarella, E.S.; Carelli, S.; Lombardi, G.; Cesarano, M.; Gennenzi, V.; et al. Use of High-Dose Nebulized Colistimethate in Patients with Colistin-Only Susceptible Acinetobacter baumannii VAP: Clinical, Pharmacokinetic and Microbiome Features. Antibiotics 2023, 12, 125. https://doi.org/10.3390/antibiotics12010125
De Pascale G, Pintaudi G, Lisi L, De Maio F, Cutuli SL, Tanzarella ES, Carelli S, Lombardi G, Cesarano M, Gennenzi V, et al. Use of High-Dose Nebulized Colistimethate in Patients with Colistin-Only Susceptible Acinetobacter baumannii VAP: Clinical, Pharmacokinetic and Microbiome Features. Antibiotics. 2023; 12(1):125. https://doi.org/10.3390/antibiotics12010125
Chicago/Turabian StyleDe Pascale, Gennaro, Gabriele Pintaudi, Lucia Lisi, Flavio De Maio, Salvatore Lucio Cutuli, Eloisa Sofia Tanzarella, Simone Carelli, Gianmarco Lombardi, Melania Cesarano, Veronica Gennenzi, and et al. 2023. "Use of High-Dose Nebulized Colistimethate in Patients with Colistin-Only Susceptible Acinetobacter baumannii VAP: Clinical, Pharmacokinetic and Microbiome Features" Antibiotics 12, no. 1: 125. https://doi.org/10.3390/antibiotics12010125