[Inhaled colistin in elderly patients with non-cystic fibrosis bronchiectasis and chronic Pseudomonas aeruginosa bronchial infection].
BACKGROUND
Bronchiectasis is a frequent cause of admission for elderly patients and chronic respiratory diseases. Although some guidelines recommend long-term treatment with inhaled antibiotics in non-cystic fibrosis bronchiectasis with chronic Pseudomonas aeruginosa (P. aeruginosa) infection, there is limited evidence supporting these prolonged antibiotic treatments in this population. The aim of this study was to assess the effectiveness of inhaled colistin in elderly patients with bronchiectasis and chronic bronchial P. aeruginosa infection in reducing hospital readmissions.


METHODS
A prospective, controlled and open label study was conducted on patients with bronchiectasis diagnosed by computed tomography and persistence of P. aeruginosa in sputum after appropriate antimicrobial therapy. All patients received education, and physiotherapy training. The intervention group also received nebulized colistin 1 million IU twice a day for one year. Data were collected on the demographics, clinical and functional characteristics, admissions in previous year, and sputum microbiology. Patients were followed up every two months for one year, with readmissions, microbiological results, functional tests, and deaths being evaluated.


RESULTS
The study included 39 patients, of whom 20 received nebulized colistin and 19 conventional therapy. There were no differences between the two groups in baseline clinical and functional characteristics or previous hospital stay. The mean age was 77.7+/-5, Charlson index 2.85, and FEV1% 41.3+/-15. Five patients (25%) stopped the nebulized treatment because of adverse effects. P. aeruginosa was eradicated in 45% of the colistin treated patients, and in only one of the control group (statistically significant), but at the end of the study year, there were no differences in the number of hospital admissions (control group 1.6+/-1.7 and 2.7+/-3 colistin group), or days of stay (19+/-31 and 23+/-20). There were no differences in lung function or clinical symptoms between the two groups No significant changes were observed in P. aeruginosa A antibiotic sensitivity or in sputum flora.


CONCLUSIONS
More patients in the treatment group achieved Pseudomonas eradication, but benefits in clinical symptoms, lung function or use of healthcare resources in our elderly patients, could not be demonstrated. Adverse effects were common. Further studies are needed in order to identify factors associated with response, or subgroups of patients with bronchiectasis and chronic infection with P. aeruginosa, who benefit from (expensive) long term treatments with inhaled antibiotics.
Servicio de Neumología, Hospital de Santa Marina, Bilbao, España. Electronic address: evataberna@yahoo.es.
Eva
E
Tabernero Huguet
Servicio de Neumología, Hospital de Santa Marina, Bilbao, España.
Pilar
P
Gil Alaña
Servicio de Neumología, Hospital de Santa Marina, Bilbao, España.
Ramón
R
Alkiza Basañez
Servicio de Neumología, Hospital de Santa Marina, Bilbao, España.
Anibal
A
Hernández Gil
Servicio de Neumología, Hospital de Santa Marina, Bilbao, España.
Javier
J
Garros Garay
Servicio de Dermatología, Hospital de Galdakao, Galdaao, Vizcaya, España.
Juan Luis
JL
Artola Igarza
D000280:Administration, Inhalation; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001982:Bronchial Diseases / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*; D001987:Bronchiectasis / Q000150:complications / Q000188:drug therapy*; D002908:Chronic Disease; D003091:Colistin / Q000008:administration & dosage*; D003550:Cystic Fibrosis; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa
D000900:Anti-Bacterial Agents; D003091:Colistin
Ancianos; Antibióticos inhalados; Bronchiectasis; Bronquiectasias; Elderly; Nebulized antibiotics