Efficacy of adjunctive nebulized colistin in critically ill patients with nosocomial carbapenem-resistant gram-negative bacterial pneumonia: a multi-centre observational study
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 ICU-admitted patients 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) vs. 46% (150/326), and 14.9% (27/181) vs. 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] vs. 54.2% [90/166], p=0.016; model 2: 35.3% [41/116] vs. 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% confidence interval [CI] 0.37-0.92; model 2: aOR 0.37, 95% CI 0.21-0.65). Nebulized colistin was not associated independently with…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 181 participants or records.
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