Prevention of gram-negative bacillary pneumonia using polymyxin aerosol as prophylaxis. II. Effect on the incidence of pneumonia in seriously ill patients.
All 744 patients admitted to a Respiratory-Surgical Intensive Care Unit (RSICU) were included in a prospective study of the effects of a polymyxin (2.5 mg/kg body wt/day in six divided doses) or a placebo aerosol sprayed into the posterior pharynx and tracheal tube (if present), during 11 alternating 2-mo treatment cycles. The incidence of upper airway colonization in the RSICU with Pseudomonas aeruginosa was 1.6% during the polymyxin treatment cycles (total 374 patients) and 9.7% during the placebo cycles (370 patients) (X2 equals 23.2, P less than 0.01). 3 patients in the RSICU acquired Pseudomonas pneumonia, as defined by independent "blinded" assessors, during the polymyxin cycles while 17 acquired a Pseudomonas pneumonia during the placebo cycles (X2 equals 10.2, P less than 0.01). The overall mortality was similar in both placebo and polymyxin-treated groups (12.2 vs. 12.0%). Systemic antibiotic usage was similar in the different cycles; 49% of patients in the placebo and 53% in the polymyxin-treated groups received systemic antibiotics while in the RSICU.
D000336:Aerosols; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001419:Bacteria / Q000254:growth & development / Q000302:isolation & purification; D001900:Boston; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D008875:Middle Aged; D010919:Placebos; D011014:Pneumonia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011113:Polymyxins / Q000008:administration & dosage* / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000517:prevention & control*; D011550:Pseudomonas aeruginosa / Q000254:growth & development / Q000302:isolation & purification; D012131:Respiratory Insufficiency / Q000188:drug therapy; D012137:Respiratory System / Q000382:microbiology; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use
D000336:Aerosols; D000900:Anti-Bacterial Agents; D010919:Placebos; D011113:Polymyxins; D012965:Sodium Chloride