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Table 1 Demographics, clinical features, responsible pathogens, and outcomes of patients treated with aerosolized colistin

From: Aerosolized colistin for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria in patients without cystic fibrosis

Characteristic

Patient

 

1

2

3

4

5

6

7

8

Medical history

Fatty liver, arterial hypertension

Smoking, arterial hypertension, pulmonary oedema, heart attack, mild chronic renal failure

Liver hamartoma, chronic obstructive pulmonary disease, urinary incontinence, hypothyroidism, Sjögren's syndrome, excised left frontal lobe meningioma

Catarract, cholosteatoma, arterial hypertension, urinary tract infection 3 weeks before admission

Wolff–Parkinson–White syndrome, chronic renal failure (polycystic kidney disease), ankylosing spondylitis

Smoking, obesity, chronic obstructive pulmonary disease

Arterial hypertension, chronic renal dysfunction (creatinine clearance 75–80 ml/min), adenoma of hypophysis, epileptic seizures, cerebral haemorrhage

Arterial hypertension, cerebral arteriovenous malformation

Reason for admission

Stomach lymphoma

Acute myocardial infarction

Epileptic seizures

Fever, headache

Multitrauma patient, C4–C5 fractures due to car accident, functional dissection of spinal cord, haemothorax

Oesophageal perforation

Adenoma of hypophysis, cerebral haemorrhage

Pneumonia, sleep apnoea syndrome, cerebral haemorrhage

Discharge diagnosis

Stomach lymphoma, nosocomial pneumonia

Acute myocardial infarction, nosocomial pneumonia

Postsurgical intracranial haematoma, pulmonary embolism, inferior vena cava filter placement

Pneumococcal meningitis, hydrocephalus, pulmonary embolism, pneumonia, urinary tract infection

Septic shock, multiple organ failure

Mediastinitis

Pneumonia

Pneumonia, sleep apnoea syndrome, cerebral haemorrhage

APACHE II score on ICU admission

14

17

17

9

12

17

19

12

APACHE II score on first day of colistin treatment

10

29

19

8

19

20

18

14

Surgery during hospitalization

Liver biopsy, partial gastrectomy

Coronary artery bypass surgery

Drainage of postsurgical haematoma of left frontal lobe, inferior vena cava filter placement

Endoscopic ethmoidectomy, surgical drainage of the frontal and maxillary sinuses

Spinal arthrodesis surgery (C5–T1)

Surgical repair of oesophageal perforation

Excision of pituitary adenoma

Embolization of arteriovenous malformation

Duration of mechanical ventilation (days)

10

16

5

18

65

25

8

8

Time from ICU admission to develop the infection for which aerosolized colistin was given (days)

8

1

7

22

24

1

7

5

Site of infection

Pneumonia (VAP)

Pneumonia, urinary tract infection

Bacteraemia, pneumonia (VAP)

Pneumonia (VAP)

Pneumonia (VAP)

Pneumonia

Pneumonia (VAP)

Pneumonia (VAP)

Isolated micro-organism (source)

Acinetobacter baumannii (BAL)

A baumannii (bronchial secretions)

A baumannii (blood), A baumannii (bronchial secretions)

Pseudomonas aeruginosa (bronchial secretions)

A baumannii (bronchial secretions)

A baumannii (BAL)

A baumannii (bronchial secretions)

A baumannii (bronchial secretions)

Susceptibility of the isolated pathogen

MDR (sensitive to colistin and gentamycin)

COS

COS

COS

MDR (sensitive to colistin and gentamycin)

COS

MDR (sensitive to colistin and gentamycin)

MDR (sensitive to colistin and gentamycin)

Duration/dosage of nebulized colistin

6 days/1 million IU q8 h

13 days/1 million IU q8 h

10 days/0.5 million IU q8 h

5 days/1.5 million IU q8 h

7 days/2 million IU q8 h

3 days/1 million IU q8 h

8 days/0.5 million IU q6 h

19 days/1 million IU q8 h

Duration/dosage of concomitant intravenous antibiotic treatment

Colistin: 2 days/3 million IU q8 h, 6 days/2 million IU q8 h

Levofloxacin: 3 days/500 mg q24 h

Co-trimoxazole: 4 days/3 ampules q8 h

Ciprofloxacin 4 days/400 mg q12 h

Colistin: 14 days/1 million IU q8 h

Meropenem: 12 days/1 g q12 h

Colistin: 26 days/3 million IU q8 h

Meropenem: 26 days/2 g q8 h

She received intravenous colistin before nebulized treatment (7 days/1 million IU q8 h) and after the end of nebulized treatment (32 days/1 million IU q8 h)

Tobramycin: 7 days/80 mg q24 h

Aztreonam: 3 days/1 g q8 h

Colistin: 14 days/2 million IU q8 h

Meropenem: 15 days/2 g q8 h

Gentamicin: 8 days/80 mg q8 h

Colistin: 8 days/2 million IU q8 h

Meropenem: 4 days/2 g q8 h

Meropenem: 27 days/2 g q8 h

Gentamicin: 27 days/80 mg q8 h

Duration of hospitalization (days)

17

16

41

234

94

25

36

40

Duration of ICU stay (days)

11

16

21

62

95

25

13

20

Outcome of infection

Cure

Improvement

Cure

Improvement

Deterioration

Improvement

Cure

Cure

Outcome of patient

Discharge

Discharge

Discharge

Discharge

Death

Discharge

Discharge

Discharge

Serum creatinine value (mg/dl) on the first day of aerosolized colistin administration

1.1

5.2

1

0.4

2.4

0.6

0.8

0.8

Serum creatinine value (mg/dl) at the end of aerosolized colistin administration

0.8

4.5

0.9

0.5

3.8

0.5

0.7

0,6

  1. APACHE, Acute Physiology and Chronic Health Evaluation; BAL, bronchoalveolar lavage; COS, colistin-only-sensitive; ICU, intensive care unit; MDR, multidrug-resistant; VAP, ventilator-associated pneumonia.