Treatment of Ventilator-Associated Pneumonia Using Intravenous Colistin Alone or in Combination with Inhaled Colistin in Critically Ill Children.
OBJECTIVE
The objective of this study was to compare the safety and efficacy of inhaled plus intravenous (IV) colistin with that of IV colistin alone in critically ill children with ventilator-associated pneumonia (VAP) due to colistin-only susceptible (COS) Gram-negative bacteria (GNB).


METHODS
This retrospective cohort study included critically ill children aged 1 month to 18 years with culture-documented monomicrobial VAP due to COS GNB.


RESULTS
Fifty patients were included, and 32 patients received IV colistin alone, whereas 18 patients received inhaled plus IV colistin. No between-cohort differences were observed in clinical (p = 0.49) and microbiological outcomes (p = 0.68), or VAP-related mortality (p = 0.99). Although the bacterial eradication rates did not differ in either treatment group, the median time to bacterial eradication (TBE) was significantly shorter in the inhaled plus IV colistin group than in the IV colistin group. The additional use of inhaled colistin was the only independent factor associated with TBE, and it shortened the median TBE by 3 days. Only one patient in the IV colistin group developed reversible nephrotoxicity. Mild bronchoconstriction was observed in three patients at the time of administration of the first doses of inhaled colistin, which did not require discontinuation of treatment.


CONCLUSIONS
The present study has demonstrated that the addition of inhaled colistin to IV colistin led to a shorter TBE in critically ill children with VAP due to COS GNB. However, it did not lead to a significant difference in the clinical and microbiological outcomes of VAP.
Department of Paediatric Infectious Diseases, Gazi University School of Medicine, Ankara, Turkey, meltemtemizhan@gmail.com.
Meltem
M
Polat
Soner Sertan
SS
Kara
Anıl
A
Tapısız
Hasan
H
Tezer
Gökhan
G
Kalkan
Anıl
A
Dolgun
D000280:Administration, Inhalation; D061605:Administration, Intravenous; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D003091:Colistin