title: Nebulised colistin for ventilator-associated pneumonia prevention.
abstract: We evaluated whether prophylactic nebulised colistin could reduce ventilator-associated pneumonia (VAP) rates in an intensive care unit (ICU) setting with prevalent multidrug-resistant (MDR) bacteria.We used a single-centre, two-arm, randomised, open-label, controlled trial in a 12-bed ICU in the University Hospital of Larissa, Greece. Patient inclusion criteria included mechanical ventilation of >48 h. The two arms consisted of prophylaxis with 500 000 U colistin (Col group) or normal saline (NS group), thrice daily, for the first 10 ICU days or until extubation. The primary outcome of the study was the 30-day VAP incidence.In total, 168 patients entered the study. VAP incidence was not different between Col and NS group patients (14 (16.7%) versus 25 (29.8%), respectively, p=0.07). Regarding the secondary outcomes, the intervention resulted in a lower VAP incidence density rate (11.4 versus 25.6, respectively, p<0.01), and less Gram-negative bacteria-VAP (p=0.03) and MDR-VAP (p=0.04). Among VAP patients (n=39), prophylaxis with inhaled colistin improved ICU survival (p=0.016). There was no evidence of increased resistance to colistin or multidrug resistance.Our findings suggest that nebulised colistin had no significant effect on VAP incidence.
authors.affiliation: Critical Care Dept, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Marios
authors.initials: M
authors.lastname: Karvouniaris
authors.affiliation: Critical Care Dept, University of Thessaly, University Hospital of Larissa, Larissa, Greece appollon7@hotmail.com.
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Makris
authors.affiliation: Critical Care Dept, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Paris
authors.initials: P
authors.lastname: Zygoulis
authors.affiliation: Critical Care Dept, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Triantaris
authors.affiliation: Microbiology Laboratory, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Stelios
authors.initials: S
authors.lastname: Xitsas
authors.affiliation: Critical Care Dept, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mantzarlis
authors.affiliation: Microbiology Laboratory, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Efthimia
authors.initials: E
authors.lastname: Petinaki
authors.affiliation: Critical Care Dept, University of Thessaly, University Hospital of Larissa, Larissa, Greece.
authors.forename: Epaminondas
authors.initials: E
authors.lastname: Zakynthinos
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003091:Colistin / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin