High-Dose Inhaled Colistin-Aminoglycoside Combination Therapy in Critically Ill Patients With Multidrug-Resistant Pseudomonas aeruginosa Hospital/Ventilator-Associated Pneumonia: A Case Report and Literature Review
Abstract
Background: Multidrug-resistant Pseudomonas aeruginosa (MDR PA) ventilator-associated pneumonia (VAP) and hospital-associated pneumonia (HAP) are associated with high morbidity and limited therapeutic options. Intravenous antibiotics often achieve inadequate pulmonary concentrations. Aerosolized delivery permits high local drug exposure, but data on combined inhaled polymyxin-aminoglycoside therapy remain limited.
Case report: We describe three critically ill patients with HAP/VAP due to MDR PA. All received adjunctive high-dose inhaled colistin immediately followed by inhaled amikacin or tobramycin, in addition to systemic therapy. Dosing was individualized based on renal function. Nebulization was optimized using inspiratory-synchronized delivery. All patients demonstrated clinical improvement, reductions in inflammatory markers (though with a transient rise in one or more markers in two patients), radiologic resolution, and eventual microbiologic eradication, despite isolates reported as resistant to the aminoglycoside and colistin used in vitro. No nephrotoxicity, bronchospasm, or device-related complications were observed clinically, despite doses exceeding those commonly reported, although formal ototoxicity surveillance was not performed. However, because all patients also received concurrent systemic antibiotics, a specific causal contribution from inhaled therapy cannot be fully established.
Conclusions: Dual inhaled colistin-aminoglycoside therapy may represent a…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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