Comparison of different colistin sulfate regimens for carbapenem-resistant gram-negative bacteria pneumonia in neurocritical care patients: a retrospective cohort study

TL;DR

This study compared different ways of giving colistin sulfate to treat pneumonia caused by drug-resistant bacteria in critically ill patients, finding that combining nebulized and intravenous methods was more effective.

Contribution

The study provides new evidence that combining nebulized and intravenous colistin sulfate improves outcomes for CR-GNB pneumonia in neurocritical care patients.

Findings

Intravenous colistin sulfate alone had higher clinical failure rates than nebulized or combined regimens.

Combined nebulized and intravenous colistin sulfate led to better microbiological eradication and shorter ICU and hospital stays.

Intravenous colistin sulfate was independently associated with higher clinical failure on day 14.

Abstract

Nosocomial infection caused by carbapenem-resistant gram-negative bacteria
(CR-GNB) is a common problem in neurocritical care patients. Clinical
evidence suggests that polymyxins have benefits for CR-GNB pneumonia. This
study compared the efficacy and safety of different colistin sulfate
regimens in CR-GNB pneumonia. Among 133 neurocritical care patients with
CR-GNB pneumonia in the intensive care unit (ICU), 24 received nebulized
colistin sulfate alone (NC group); 38 received intravenous colistin sulfate
alone (IV group); and 71 received nebulized plus intravenous colistin
sulfate (NCIV group). After inverse probability of treatment weighting
(IPTW), clinical failure rates on days 7 and 14 were significantly higher in
the IV group than in the NC group (38.3% vs. 20.5%, P =
0.017 and 32.1% vs. 15.3%, P = 0.004, respectively) and the
NCIV group (38.3% vs. 24.7%, P = 0.023 and 32.1% vs. 14.2%,
P = 0.015, respectively). Moreover, the IV group also
reported a lower microbiological eradication rate on day 14
(P = 0.031) and longer ICU (P = 0.020)
and hospital stays (P = 0.037) than the NCIV group. No
significant difference in mortality risk and nephrotoxicity among the
groups. In multivariable analysis, intravenous colistin sulfate was an
independent factor associated with higher clinical failure on day 14
(adjusted odds ratio = 5.92, 95% CI = 1.14–30.84, P
= 0.035). Our study suggested that nebulized colistin sulfate with
concurrent intravenous administration may be an effective and safe option
for CR-GNB pneumonia.

Figures