title: Is inhaled colistin beneficial in ventilator associated pneumonia or nosocomial pneumonia caused by Acinetobacter baumannii?
abstract: BACKGROUND
  In the present study, our objective was to evaluate and compare the clinical and microbiological results in patients receiving systemic and systemic plus inhaled colistin therapy due to nosocomial pneumonia (NP) or ventilator associated pneumonia (VAP) caused by Acinetobacter baumannii.
  
  
  METHODS
  A retrospective matched case-control study was performed at the ICUs at Izmir Katip Celebi University Ataturk Training and Research Hospital from January 2013 to December 2014. Eighty patients who received only systemic colistin were matched 43 patients who received systemic colistin combined with inhaled therapy.
  
  
  RESULTS
  In 97.6 % of the patients colistin was co-administered with at least one additional antibiotic. The most frequently co-administered antibiotics were carbapenems (79.7 %). The patient groups did not differ significantly in terms of the non-colistin antibiotics used for treatment (p > 0.05). Acute renal injury was observed in 53.8 % and 48.8 % of the patients who received parenteral colistin or parenteral plus inhaler colistin, respectively (p = 0.603). There were no significant differences between the groups in terms of clinical success (p = 0.974), clinical failure (p = 0.291), or recurrence (p = 0.094). Only, a significantly higher partial clinical improvement rate was observed in the systemic colistin group (p = 0.009). No significant differences between the two groups in terms of eradication (p = 0.712), persistence (p = 0.470), or recurrence (p = 0.356) rates was observed. One-month mortality rate was similar in systemic (47.5 %) and systemic plus inhaled (53.5 %) treatment groups (p = 0.526).
  
  
  CONCLUSIONS
  Our results suggest that combination of inhaled colistin with intravenous colistin had no additional therapeutic benefit in terms of clinical or microbiological outcomes.
authors.affiliation: Department of Infectious Disease, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basin sitesi, 35360, Izmir, Karabaglar, Turkey. tuna.demirdal@ikc.edu.tr.
authors.forename: Tuna
authors.initials: T
authors.lastname: Demirdal
authors.affiliation: Department of Infectious Disease, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basin sitesi, 35360, Izmir, Karabaglar, Turkey. dr.kuru_88@hotmail.com.
authors.forename: Ummu Sena
authors.initials: US
authors.lastname: Sari
authors.affiliation: Department of Infectious Disease, Faculty of Medicine, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basin sitesi, 35360, Izmir, Karabaglar, Turkey. atanemli@yahoo.com.
authors.forename: Salih Atakan
authors.initials: SA
authors.lastname: Nemli
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D040981:Acinetobacter baumannii; D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D016022:Case-Control Studies; D003091:Colistin / Q000008:administration & dosage*; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin