Colistin nebulization improves clinical outcomes in ICU-admitted patients with nosocomial pneumonia

The study summary is given as follows:

• The study included subjects without intravenous colistin treatment.
• The subjects were categorized based on substitutive nebulized colistin use alongside IV antibiotics.
• Between the two groups, a comparison was made between clinical responses and the mortality rate.
• The study included 343 and 214 patients with and without substitutive nebulized colistin, respectively.
• The clinical failure rate on days 7, 14 and 28 was 22.6 vs 42.6%, 27.0 vs 42.6% and 27.8 vs 41.7%. (PS matched cohort). This was lower in patients with nebulized colistin.
• Nebulized colistin was an independent factor which was associated with lower day 14 clinical failure.
• The Original cohort had an adjusted odds ratio (aOR) of 0.45
• The PS-matched cohort had aOR of 0.48.
• The clinical failure rate and mortality rate had no difference between patients receiving high (> 6 MIU/day) and low (≤ 6 MIU/day) doses of nebulized colistin in the PS-matched cohort.

To conclude, the study reports substitutive nebulized colistin with better clinical outcomes. Our findings are only applicable in endemic HAP/VAP caused by CR-GNB, mainly CRAB, they said.

The researchers wrote that a further prospective study is required elucidate the clinical benefits of substitutive nebulized colistin, including the application of high-dose nebulized colistin in specific populations.

Further reading:

Feng et al. role of nebulized colistin as a substitutive strategy against nosocomial pneumonia caused by CR-GNB in intensive care units: a retrospective cohort study. Ann. Intensive Care 13, 1 (2023). https://doi.org/10.1186/s13613-022-01088-4