Efficacy of adjunctive nebulized colistin in critically ill patients with nosocomial carbapenem-resistant Gram-negative bacterial pneumonia: a multi-centre observational study

doi:10.1016/j.cmi.2021.01.020

中山醫學大學機構典藏 CSMUIR > 中山醫學大學研究成果 > 期刊論文 > Item 310902500/23719

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Title:	Efficacy of adjunctive nebulized colistin in critically ill patients with nosocomial carbapenem-resistant Gram-negative bacterial pneumonia: a multi-centre observational study
Authors:	Feng, JY;Peng, CK;Sheu, CC;Lin, YC;Chan, MC;Wang, SH;Chen, CM;Shen, YC;Zheng, ZR;Lin, YT;Yang, KY
Keywords:	Carbapenem-resistant Gram-negative bacteria;Clinical failure;Colistin;Mortality;Nosocomial pneumonia
Date:	2021
Issue Date:	2022-08-05T09:41:47Z (UTC)
Publisher:	ELSEVIER SCI LTD
ISSN:	1198-743X
Abstract:	Objectives: To investigate the association between adjunctive nebulized colistin and treatment outcomes in critically ill patients with nosocomial carbapenem-resistant Gram-negative bacterial (CR-GNB) pneumonia. Methods: This retrospective, multi-centre, cohort study included individuals admitted to the intensive care unit with nosocomial pneumonia caused by colistin-susceptible CR-GNB. Enrolled patients were divided into groups with/without nebulized colistin as adjunct to at least one effective intravenous antibiotic. Propensity score matching was performed in the original cohort (model 1) and a time-window bias-adjusted cohort (model 2). The association between adjunctive nebulized colistin and treatment outcomes was analysed. Results: In total, 181 and 326 patients treated with and without nebulized colistin, respectively, were enrolled for analysis. The day 14 clinical failure rate and mortality rate were 41.4% (75/181) versus 46% (150/326), and 14.9% (27/181) versus 21.8% (71/326), respectively. In the propensity score-matching analysis, patients with nebulized colistin had lower day 14 clinical failure rates (model 1: 41% (68/ 166) versus 54.2% (90/166), p 0.016; model 2: 35.3% (41/116) versus 56.9% (66/116), p 0.001). On multivariate analysis, nebulized colistin was an independent factor associated with fewer day 14 clinical failures (model 1: adjusted odds ratio (aOR) 0.59, 95% CI 0.37-0.92; model 2: aOR 0.37, 95% CI 0.21-0.65). Nebulized colistin was not associated independently with a lower 14-day mortality rate in the time-dependent analysis in both models 1 and 2. Conclusions: Adjunctive nebulized colistin was associated with lower day 14 clinical failure rate, but not lower 14-day mortality rate, in critically ill patients with nosocomial pneumonia caused by colistinsusceptible CR-GNB. Jia-Yih Feng, Clin Microbiol Infect 2021;27:1465 (c) 2021 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
URI:	http://dx.doi.org/10.1016/j.cmi.2021.01.020 https://www.webofscience.com/wos/woscc/full-record/WOS:000707717400016 https://ir.csmu.edu.tw:8080/handle/310902500/23719
Relation:	CLINICAL MICROBIOLOGY AND INFECTION ,2021,v27,issue 10, P1465-1473
Appears in Collections:	[中山醫學大學研究成果] 期刊論文

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