Prevention of gram negative nosocomial bronchopneumonia by intratracheal colistin in critically ill patients. Histologic and bacteriologic study.
OBJECTIVE
To evaluate the efficiency of intratracheal colistin in preventing nosocomial bronchopneumonia (BPN) in the critically ill.


METHODS
Study evaluating the clinical incidence of nosocomial BPN in 2 groups of critically ill patients who receive or did not receive intratracheal colistin. BPN was assessed clinically in survivors and histologically in non-survivors.


METHODS
A 14-bed surgical intensive care unit.


METHODS
598 consecutive critically ill patients were studied during a prospective non-randomized study over a 40-month period.


METHODS
251 patients--31 non-survivors and 220 survivors--did not receive intratracheal colistin and 347-42 non-survivors and 305 survivors--received intratracheal colistin for a 2-week period (1,600,000 units per 24 h).


RESULTS
The incidence of nosocomial BPN was evaluated clinically in survivors, using repeated protected minibronchoalveolar lavages, and histologically in non-survivors via an immediate postmortem pneumonectomy (histologic and semi-quantitative bacteriologic analysis of one lung). The clinical incidence of nosocomial BPN was of 37% in coli (-) survivors and of 27% in coli (+) survivors (p < 0.01). This result was histologically confirmed in non-survivors, where the incidence of histologic BPN was of 61% in coli (-) patients and of 36% in coli (+) patients (p < 0.001). Emergence of BPN due to colistin-resistant micro-organisms was not observed. Because colistin was successful in preventing Gram-negative BPN and did not change the absolute number of Gram-positive BPN, the proportion of BPN caused by staphylococcus species was higher in group coli (+) patients (33% vs 16%). Mortality was not significantly influenced by the administration of colistin.


CONCLUSIONS
This study suggests that the administration of intratracheal colistin during a 2-week period significantly reduces the incidence of Gram-negative BPN without creating an increasing number of BPN due to colistin-resistant micro-organisms.
Département d'Anesthésie, Hôpital de la Pitié-Salpétrière, Université Paris VI, France.
J J
JJ
Rouby
P
P
Poète
E
E
Martin de Lassale
M H
MH
Nicolas
L
L
Bodin
V
V
Jarlier
A M
AM
Korinek
P
P
Viars
D000368:Aged; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D003091:Colistin / Q000627:therapeutic use*; D016638:Critical Illness; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004341:Drug Evaluation; D004352:Drug Resistance, Microbial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D007322:Instillation, Drug; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011013:Pneumonectomy; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects; D015996:Survival Rate
D003091:Colistin