Safety in treatment of ventilator-associated pneumonia due to extensive drug-resistant Acinetobacter baumannii with aerosolized colistin in neonates: a preliminary report.
BACKGROUND
Infections caused by extensive drug-resistant Acinetobacter baumannii (XDR-AB) have been increasingly observed and are associated with a high mortality rate. We present our experience using aerosolized colistin for the treatment of ventilator-associated pneumonia (VAP) due to XDR-AB in neonates.


METHODS
The clinical data of neonates who received aerosolized 4 mg per kg of colistin base twice daily as an adjunctive therapy for VAP caused by XDR-AB between July 2008 and September 2009 were retrospectively reviewed. The outcomes were compared with the neonates with VAP from XDR-AB in October 2006-September 2007 who did not receive aerosolized colistin.


RESULTS
During the study period, eight neonates (three preterm and five term neonates) with VAP caused by XDR-AB received aerosolized colistin. All isolated pathogens from the tracheobronchial specimens of the eight patients were XDR-AB susceptible to colistin only. Six patients received aerosolized colistin without concomitant intravenous colistin. All children were cured with eradication of XDR-AB from respiratory secretions. Seven patients survived and were discharged from the hospital, and one died from bacterial sepsis unrelated to the VAP episode. There were no clinical or laboratory adverse events related to aerosolized colistin. Compared to the seven neonates in the earlier period, the neonates who received aerosolized colistin had higher birth weight and gestational age, and lower mortality rate (13% vs. 71%, P=0.04).


CONCLUSIONS
Aerosolized colistin may be a useful adjunctive therapy in VAP due to XDR-AB. The use of aerosolized colistin in neonates should be investigated in a larger controlled study.
Nakwan
Narongsak
N
Neonatal Intensive Care Unit, Hat Yai Medical Education Center, Hat Yai Hospital, Songkhla, Thailand. nnakwan@hotmail.com
Wannaro
Jeerawan
J
Thongmak
Tipaporn
T
Pornladnum
Pornpat
P
Saksawad
Ratchanee
R
Nakwan
Narongwit
N
Chokephaibulkit
Kulkanya
K
D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000280:Administration, Inhalation; D000336:Aerosols; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy; D001724:Birth Weight; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D013785:Thailand; D016896:Treatment Outcome
D000336:Aerosols; D000900:Anti-Bacterial Agents; D003091:Colistin