Efficacy and Safety of Different Colistin Administration Routes for Nosocomial Pneumonia Caused by Carbapenem-Resistant Organisms: A Single Centre, Open Label, Prospective Cohort Study
Abstract
Background The role of inhaled colistin as either an adjunctive or substitution for nosocomial pneumonia (NP) caused by carbapenem-resistant organisms (CRO) is highly debated due to conflicting clinical evidence. Given the limitations of intravenous therapy, the optimal administration strategy remains a critical, unresolved question. This study aimed to compare the efficacy and safety of three colistin-based regimens administered via different routes. Methods In this prospective cohort study, 127 intensive care unit (ICU) patients diagnosed with CRO-related NP and treated with colistin were enrolled. Patients were classified into three groups according to the route of administration: inhalation (IH group), intravenous colistin with adjunctive inhalation (IV+IH group), and intravenous (IV group) therapy. The primary endpoint was clinical efficacy at the end of treatment. Key secondary outcomes included microbiological eradication and nephrotoxicity. Results Clinical efficacy was achieved in 72.1% of the IH group, 67.4% of the IV+IH group, and 65% of the IV group, with no statistically significant difference among groups (P=0.786). The IH group demonstrated a significantly higher microbiological eradication rate compared with the IV group (P=0.004). No significant differences were observed in 28-day all-cause mortality, hospital stay duration, or incidence of acute kidney injury (AKI). Moreover, the development of AKI during treatment was strongly associated with clinical…
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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.
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