Inhalatory and intravenous colistin in treating ventilator-associated pneumonia due to Acinetobacter species: should we combine them?

Jovan Matijašević; Srdjan Gavrilović; Ilija Andrijević; Ana Andrijević; Svetislava Milić; Marija  Vukoja

doi:10.2298/VSP180910161M

Jovan Matijašević Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
Srdjan Gavrilović Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
Ilija Andrijević Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
Ana Andrijević Institute for pulmonary diseases of Vojvodina, Sremska Kamenica, SerbiaInstitute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
Svetislava Milić Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
Marija Vukoja Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia

DOI: https://doi.org/10.2298/VSP180910161M

Ključne reči: pneumonija, respiratorom uzrokovana, acinetobacter, kolistin, inhalaciona primena, infuzije, intravenske, lečenje ishod

Sažetak

Uvod/Cilj. Acinetobacter je jedan od najčećih uzročnika nozokomijalnih infekcija, posebno pneumonije udružene sa upotrebom ventilatora (VAP). Uzimajući u obzir da je sve veći broj multirezistentnih mikroorganizama, uz nedostatak novih antibiotika, kolistin je našao svoje mesto u lečenju životno ugrožavajućih nozokomijalnih infekcija. Intravenska primena antibiotika je zlatni standard u lečenju pneumonija, ali dodatak inhalatorne, njihovoj sistemskoj primeni u lečenju VAP, pokazala je svoje prednosti u nekim istraživanjima. Cilj naše studije bio je da se ispita efekat inhalatorne primene kolistina, kao dodatka intravenskom načinu primene, na preživljavanje bolesnika sa VAP čiji je uzročnik Acinetobacter. Metode. Sprovedena je retrospektivna studija kako bi se procenila efikasnost kombinovane inhalatorne i intravenske primene kolistina u odnosu na samo intravensku primenu leka, kod 69 bolesnika sa VAP izazvanim Acinetobacter spp. Bolesnici su lečeni u periodu od januara 2013. do marta 2018. godine u Jedinici intenzivnog lečenja Instituta za plućne bolesti Vojvodine u Sremskoj Kamenici (Srbija). Prikupljeni su osnovni demografski podaci, podaci o težini bolesti, komorbiditetima, režimu kolistina i dužini lečenja. Primarni cilj studije bio je 28-dnevni mortalitet. Rezultati. Dvadeset sedam od ukupno 69 (39,1%) bolesnika primalo je kominaciju intravenskog i inhalatoronog kolistina. Kod 42 bolesnika dat je samo intravenski kolistin (60,9%). U poređenju sa bolesnicima kod kojih je primenjena kombinacija intravenskog i inhalatornog kolistina, bolesnici kod kojih je primenjen samo intravenozni kolistin imali su statistički značajno veći rizik od 28-dnevnog mortaliteta [25,9% vs. 61,9%, odds ratio (OR) 4,464; 95% confidence interval (CI) 1,539–2,925; p = 0,006]. Dužina lečenja kolistinom (preko 7 dana) takođe je bila povezana sa smanjenim preživljavanjem (OR 0,22; 95% CI 0,080–0,606; p = 0,003). Nakon prilagođavanja uzorka prema težini bolesti (APACHE skor) i dužini lečenja kolistinom, bolesnici koji su primali samo intravenozni kolistin imali su veći 28-dnevni mortalitet u poređenju sa bolesnicima lečenih kombinovanom primenom kolistina: intravenozno i inhalatorno (OR 6,305; 95% CI 1,795–22,153; p = 0,004). Zaključak. Rezultati naše studije su pokazali da bi inhalatorna primena kolistina, kao dodatak intravenoznoj primeni leka, mogla da poboljša ishod lečenja VAP uzrokovane Acinetobacter spp.

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Inhalatorni i intravenozni kolistin u lečenju ventilatorom udružene pneumonije izazvane Acinetobacter species: da li ih treba kombinovati?

Sažetak

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