title: Global survey on nebulization of antimicrobial agents in mechanically ventilated patients: a call for international guidelines.
abstract: Nebulized antimicrobial agents are increasingly administered for treatment of respiratory infections in mechanically ventilated (MV) patients. A structured online questionnaire assessing the indications, dosages and recent patterns of use for nebulized antimicrobial agents in MV patients was developed. The questionnaire was distributed worldwide and completed by 192 intensive care units. The most common indications for using nebulized antimicrobial agent were ventilator-associated tracheobronchitis (VAT; 58/87), ventilator-associated pneumonia (VAP; 56/87) and management of multidrug-resistant, Gram-negative (67/87) bacilli in the respiratory tract. The most common prescribed nebulized agents were colistin methanesulfonate and sulfate (36/87, 41.3% and 24/87, 27.5%), tobramycin (32/87, 36.7%) and amikacin (23/87, 26.4%). Colistin methanesulfonate, amikacin and tobramycin daily doses for VAP were significantly higher than for VAT (p < 0.05). Combination of parenteral and nebulized antibiotics occurred in 50 (86%) of 58 prescriptions for VAP and 36 (64.2%) of 56 of prescriptions for VAT. The use of nebulized antimicrobial agents in MV patients is common. There is marked heterogeneity in clinical practice, with significantly different in use between patients with VAP and VAT. Randomized controlled clinical trials and international guidance on indications, dosing and antibiotic combinations to improve clinical outcomes are urgently required.
authors.affiliation: UHN and Mount Sinai Hospital, University of Toronto, Canada; Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Solé-Lleonart
authors.affiliation: Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
authors.forename: J A
authors.initials: JA
authors.lastname: Roberts
authors.affiliation: Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Chastre
authors.affiliation: 4th Department of Internal Medicine, Athens University School of Medicine, Attikon University General Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Poulakou
authors.affiliation: Pulmonary, Critical Care, and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
authors.forename: L B
authors.initials: LB
authors.lastname: Palmer
authors.affiliation: Department of Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Blot
authors.affiliation: Acute Intensive Care Unit, University Hospital of South Manchester, Manchester, UK.
authors.forename: T
authors.initials: T
authors.lastname: Felton
authors.affiliation: Infectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bassetti
authors.affiliation: Service de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie of Paris, Paris, France.
authors.forename: C-E
authors.initials: CE
authors.lastname: Luyt
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, University of Porto, Porto, Portugal.
authors.forename: J M
authors.initials: JM
authors.lastname: Pereira
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, CIBERES, Vall d'Hebron Institute of Research, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Riera
authors.affiliation: Department of Pulmonary Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Welte
authors.affiliation: Critical Care Department, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China.
authors.forename: H
authors.initials: H
authors.lastname: Qiu
authors.affiliation: Department of Anesthesiology and Critical Care, Multidisciplinary Intensive Care Unit, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie (UPMC) of Paris 6, Paris, France.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Rouby
authors.affiliation: CIBERES, Universitat Autonoma de Barcelona, Spain. Electronic address: JRello@crips.es.
authors.forename: J
authors.initials: J
authors.lastname: Rello
mesh_terms: D000336:Aerosols / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D004358:Drug Therapy / Q000592:standards; D014943:Global Health; D017408:Guidelines as Topic; D006801:Humans; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000336:Aerosols; D000890:Anti-Infective Agents
keywords: Colistin; dosage; mechanical ventilated; nebulized antibiotics; pulmonary infections