Nebulized Colistin shows better microbiological clearance in Ventilator associated pneumonia

A recent study published in the Journal of Critical Care found Nebulized Colistin (NC) to be associated with better microbiological clearance but did not result impact the prognosis of ventilator-associated pneumonia (VAP). 

The study by Xiaoyu Zhang and colleagues undertook an extensive search across databases including Web of Science, PubMed, Embase, and the Cochrane Library, amassed a collection of three randomized controlled trials (RCTs) and seven observational studies. These investigations aimed to discern whether NC holds the promise it initially appeared to offer.

The primary focus was on clinical response, with secondary outcomes encompassing microbiological eradication, overall mortality, length of mechanical ventilation (MV), duration of intensive care unit stay (ICU-LOS), as well as potential adverse effects including nephrotoxicity, neurotoxicity, and bronchospasm.

Remarkably, the results indicate that while NC demonstrated a higher rate of microbiological eradication, it failed to significantly outperform traditional intravenous antibiotic therapy in terms of clinical response, overall mortality, MV duration, and ICU-LOS. This equilibrium between the two treatment approaches suggests that while NC may excel in combatting microbial pathogens, it does not translate into substantial changes in patient prognosis.

An interesting revelation from the study is the emergence of bronchospasm risk associated with NC. The findings showed a statistically significant increase in the likelihood of bronchospasm when treated with nebulized colistin, raising concerns about its safety profile.

These findings prompt the medical community to take a cautious stance when considering nebulized colistin as a VAP therapy. As the study provides a comprehensive overview of the current body of evidence, it offers a valuable resource for clinicians in making informed decisions regarding patient care. The medical fraternity awaits further studies to corroborate and expand on these findings, paving the way for more effective and tailored interventions for this serious condition.

Source:

Zhang, X., Cui, X., Jiang, M., Huang, S., & Yang, M. (2023). Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia: A systematic review and meta-analysis. In Journal of Critical Care (Vol. 77, p. 154315). Elsevier BV. https://doi.org/10.1016/j.jcrc.2023.154315