Efficacy of Nebulized Antibiotics in Treatment of Ventilator-associated Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LiHu ¹ , YangChunhui ¹ , XueYangyong ¹ , XieJuan ² , XuDan ¹ ,  TangJianguo ¹

1. Departments of Emergency and Critical Care Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, 200240, China;
2. ;

Corresponding?author：

TangJianguo, Email: tangjianguo@5thhospital.com

Keywords：

Ventilator-associated pneumonia; Aerosol therapy; Mechanical ventilation

DOI：

10.7507/1671-6205.2015067

Video：

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Objective To evaluate the effectiveness and safety of nebulized amikacin for the treatment of ventilator-associated pneumonia (VAP) caused by gram-negative bacilli. Methods From January 2010 to December 2013,a total of 120 patients with VAP due to gram-negative bacilli were randomised to a nebulized group (60 patients) and a control group (60 patients) in Shanghai Fifth People's Hospital. On the basis of similar routine treatment and systemic antibiotics based on the physicians' decision according to guidelines,the patients received 400 mg nebulized amikacin diluted in 5 mL normal saline in the nebulized group or 5 mL normal saline in the control group twice daily for 7 days. The rate of clinical cure and bacterial eradication,mortality,weaning rate and adverse events were recorded. Results At the end of nebulized treatment,the rate of clinical cure in the nebulized group was significantly higher than that in the control group (75.0% vs. 53.3%,P=0.013). So was the rate of bacterial eradication (75.0% vs. 44.4%,P=0.008). But the crude mortality and weaning rate were similar between two groups (P>0.05). The adverse events in two groups were similar too (P>0.05). When followed-up to the 28^th day,the weaning rate in the nebulized group was significantly higher than that in the control group (71.7% vs. 51.7%,P=0.024),but the crude mortality was not different (P>0.05). Conclusion Nebulized amikacin as an adjunctive therapy for the treatment of VAP,which do not demonstrate obviously adverse events,can help improve rate of clinical cure and bacterial eradication and long-term weaning rate,but can not reduce patients' crude mortality.

Citation： LiHu, YangChunhui, XueYangyong, XieJuan, XuDan, TangJianguo. Efficacy of Nebulized Antibiotics in Treatment of Ventilator-associated Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(3): 273-277. doi: 10.7507/1671-6205.2015067 Copy

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2.	Melsen WG,Rovers MM,Groenwold RH,et al. Attributable mortality of ventilator-associated pneumonia:a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis,2013,13:665-671.
3.	Kollef MH,Hamilton CW,Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol,2012,33:250-256.
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6.	Ryan G,Singh M,Dwan K. Inhaled antibiotics for long-term therapy in cystic fibrosis. Cochrane Database Syst Rev,2011:CD001021.
7.	Tumbarello M,De Pascale G,Trecarichi EM,et al. Effect of aerosolized colistin as adjunctive treatment on the outcomes of microbiologically documented ventilator-associated pneumonia caused by colistin-only susceptible Gram-negative bacteria. Chest,2013,29:1768-1775.
8.	Kofteridis DP,Alexopoulou C,Valachis A,et al. Aerosolized plus intravenous colistin versus intravenous colistin alone for the treatment of ventilator-associated pneumonia:a matched case-control study. Clin Infect Dis,2010,51:1238-1244.
9.	Rattanaumpawan P,Lorsutthitham J,Ungprasert P,et al. Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother,2010,65:2645-2649.
10.	中華醫學會重癥醫學分會.呼吸機相關性肺炎診斷、預防和治療指南(2013).中華內科雜志,2013,52:524-543.
11.	ATS. Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare-associated pneumonia. Am J Respir Crit Care Med,2005,171:388-416.
12.	孟凡亮,劉楓.霧化吸入抗生素治療呼吸機相關性肺炎的現狀.中國呼吸與危重監護雜志,2013,12:636-639.
13.	劉朝暉,陳勁龍,謝長江,等.廣州地區呼吸機相關性肺炎臨床流行病學和病原學分析.中國呼吸與危重監護雜志,2007,6:93-96.
14.	楊春輝,李虎,薛楊勇,等.霧化吸入阿米卡星氣道分泌物及血藥動力學特點.內科急危重癥雜志,2013,19:165-167.
15.	Lu Q,Yang J,Liu Z,et al. Nebulized ceftazidime and amikacin in ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Am J Respir Crit Care Med,2011,184:106-115.
16.	汪復,朱德妹,胡付品,等.2012年中國CHINET細菌耐藥性監測.中國感染與化療雜志,2013,13:321-330.

1. ?Timsit JF,Zahar JR,Chevret S. Attributable mortality of ventilator-associated pneumonia. Curr Opin Crit Care,2011,17:464-471.
2. Melsen WG,Rovers MM,Groenwold RH,et al. Attributable mortality of ventilator-associated pneumonia:a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis,2013,13:665-671.
3. Kollef MH,Hamilton CW,Ernst FR. Economic impact of ventilator-associated pneumonia in a large matched cohort. Infect Control Hosp Epidemiol,2012,33:250-256.
4. Sandiumenge A,Rello J. Ventilator-associated pneumonia caused by ESKAPE organisms:cause,clinical features,and management. Curr Opin Pulm Med,2012,18:187-193.
5. Montgomery AB,Vallance S,Abuan T,et al. A randomized double-blind placebo-controlled dose-escalation phase 1 study of aerosolized amikacin and fosfomycin delivered via the PARI investigational eFlow^? inline nebulizer system in mechanically ventilated patients. J Aerosol Med Pulm Drug Deliv,2014,27:441-448.
6. Ryan G,Singh M,Dwan K. Inhaled antibiotics for long-term therapy in cystic fibrosis. Cochrane Database Syst Rev,2011:CD001021.
7. Tumbarello M,De Pascale G,Trecarichi EM,et al. Effect of aerosolized colistin as adjunctive treatment on the outcomes of microbiologically documented ventilator-associated pneumonia caused by colistin-only susceptible Gram-negative bacteria. Chest,2013,29:1768-1775.
8. Kofteridis DP,Alexopoulou C,Valachis A,et al. Aerosolized plus intravenous colistin versus intravenous colistin alone for the treatment of ventilator-associated pneumonia:a matched case-control study. Clin Infect Dis,2010,51:1238-1244.
9. Rattanaumpawan P,Lorsutthitham J,Ungprasert P,et al. Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother,2010,65:2645-2649.
10. 中華醫學會重癥醫學分會.呼吸機相關性肺炎診斷、預防和治療指南(2013).中華內科雜志,2013,52:524-543.
11. ATS. Guidelines for the management of adults with hospital-acquired,ventilator-associated,and healthcare-associated pneumonia. Am J Respir Crit Care Med,2005,171:388-416.
12. 孟凡亮,劉楓.霧化吸入抗生素治療呼吸機相關性肺炎的現狀.中國呼吸與危重監護雜志,2013,12:636-639.
13. 劉朝暉,陳勁龍,謝長江,等.廣州地區呼吸機相關性肺炎臨床流行病學和病原學分析.中國呼吸與危重監護雜志,2007,6:93-96.
14. 楊春輝,李虎,薛楊勇,等.霧化吸入阿米卡星氣道分泌物及血藥動力學特點.內科急危重癥雜志,2013,19:165-167.
15. Lu Q,Yang J,Liu Z,et al. Nebulized ceftazidime and amikacin in ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Am J Respir Crit Care Med,2011,184:106-115.
16. 汪復,朱德妹,胡付品,等.2012年中國CHINET細菌耐藥性監測.中國感染與化療雜志,2013,13:321-330.

Chinese Journal of Respiratory and Critical Care Medicine

Efficacy of Nebulized Antibiotics in Treatment of Ventilator-associated Pneumonia

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