Inhaled Polymyxin in Treatment of Elderly Patients with Severe Community-Acquired Klebsiella pneumoniae-Induced Pneumonia
https://doi.org/10.24060/2076-3093-2020-10-4-275-280
Abstract
Background. Inhaled administration of antibacterial drugs (ABD) is a new insufficiently studied area of modern pulmonology. Its feasible advantages comprise a targeted drug delivery to the infection site, amplified antibiotic concentration in tracheobronchial secretion and reduced systemic toxicity risks. The most common inhaled ABDs include aminoglycosides and polymyxinE (colistin).
Aim. A comparison of patient cohorts with severe communityacquired pneumonia induced by Klebsiella pneumoniae receiving and not receiving inhaled colistin.
Materials and methods. The study conducted is a retrospective multicentre controlled nonrandomised assay. Among the 45 patients included, 20 were and 25 were not receiving colistin inhalation. The endpoint was survival. Data were analysed with Statistica 6.0.
Results and discussion. The cohorts differed significantly neither in the main clinical and laboratory values, nor in point scoring of severity and outcome. However, statistical significance was obtained for differences in the ALV (p = 0.04) and pneumonia resolution (p = 0.044) times.
Conclusion. Inhaled polymyxinsupplemented therapy for severe communityacquired pneumonia induced by Kl. pneumoniae significantly reduces the ALV and pneumonia resolution times in elderly and senile patients but does not affect survival.
About the Authors
V. I. Sakharov
G.G. Kuvatov Republican Clinical Hospital
Russian Federation
Russian Federation
Ufa
P. I. Mironov
Bashkir State Medical University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Prof., Department of Anesthesiology and Resuscitation with a course of Advanced Professional
Education
Ufa
I. A. Ruslykova
North-Western State Medical University named after I.I. Mechnikov
Russian Federation
Russian Federation
Cand. Sci. (Med.), Intensive Care Unit (ICU) No. 2 of the Clinic
Ufa
I. I. Lutfarakhmanov
Bashkir State Medical University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Prof., Department of Anesthesiology and Resuscitation with a course of Advanced Professional
Education
Ufa
References
1. Kuzovlev A.N., Grechko A.V. Inhaled Antibiotics in Reanimatology: Problem State and Development Prospects (Review). General Reanimatology. 2017;13(5):69–84 (In Russ.). DOI: 10.15360/1813-9779-2017-5-69-84
2. Rello J., Solé-Lleonart C., Rouby J.J., Chastre J., Blot S., Poulakou G., et al. Use of nebulized antimicrobials for the treatment of respiratory infections in invasively mechanically ventilated adults: a position paper from the European Society of Clinical Microbiology and Infectious Diseases. Clin Microbiol Infect. 2017;23(9):629–39. DOI: 10.1016/j.cmi.2017.04.011
3. Kalil A.C., Metersky M.L., Klompas M., Muscedere J., Sweeney D.A., Palmer L.B., et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61–111. DOI: 10.1093/cid/ciw353
4. Korbila I.P., Michalopoulos A., Rafailidis P.I., Nikita D., Samonis G., Falagas M.E. Inhaled colistin as adjunctive therapy to intravenous colistin for the treatment of microbiologically documented ventilatorassociated pneumonia: a comparative cohort study. Clin Microbiol Infect. 2010;16(8):1230–6. DOI: 10.1111/j.1469-0691.2009.03040.x
5. Tumbarello M., De Pascale G., Trecarichi E.M., De Martino S., Bello G., Maviglia R., 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;144(6):1768–75. DOI: 10.1378/chest.13-1018
6. Doshi N.M., Cook C.H., Mount K.L., Stawicki S.P., Frazee E.N., Personett H.A., et al. Adjunctive aerosolized colistin for multi-drug resistant gram-negative pneumonia in the critically ill: a retrospective study. BMC Anesthesiol. 2013;13(1):45. DOI: 10.1186/1471-2253-13-45
7. Beloborodov V.B., Gusarov V.G., Dekhnich A.V., Zamyatin M.N., Zubareva N.A., Zyryanov S.K., et al. Guidelines of the Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum Diagnostics and antimicrobial therapy of the infections caused by multiresistant microorganisms. Messenger of anesthesiology and resusscitation. 2020;17(1):52–83 (In Russ.). DOI: 10.21292/2078-5658-2020-16-1-52-83
8. Ahnert P., Creutz P., Horn K., Schwarzenberger F., Kiehntopf M., Hossain H., et al. Sequential organ failure assessment score is an excellent operationalization of disease severity of adult patients with hospitalized community acquired pneumonia — results from the prospective observational PROGRESS study. Crit Care. 2019;23(1):110. DOI: 10.1186/s13054-019-2316-x
9. Innocenti F., Tozzi C., Donnini C., De Villa E., Conti A., Zanobetti M., et al. SOFA score in septic patients: incremental prognostic value over age, comorbidities, and parameters of sepsis severity. Intern Emerg Med. 2018;13(3):405–12. DOI: 10.1007/s11739-017-1629-5
10. Kruglyakova L.V., Naryshkina S.V., Odireev A.N. Modern aspects of community-acquired pneumonia. Bulletin Physiology and Pathology of Respiration. 2019;(71):120–34 (In Russ.). DOI: 10.12737/article_5c89acc410e1f3.79881136
11. Dombrovskiy V.Y., Martin A.A., Sunderram J., Paz H.L. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med. 2007;35(5):1244–50. DOI: 10.1097/01.CCM.0000261890.41311.E9
12. Kim J.H., Seo J.W., Mok J.H., Kim M.H., Cho W.H., Lee K., et al. Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia. Tuberc Respir Dis (Seoul). 2013;74(5):207–14. DOI: 10.4046/trd.2013.74.5.207
13. Kuzovlev A.N., Lazarev V.V., Shabanov A.K., Kuzkov V.V., Kitiashvili I.Z., Zybin K.D., et al. Inhaled antibiotics in intensive care medicine (survey of Russian intensivists). A retrospective observational study. Annals of Critical Care. 2020;3:88–94 (In Russ.). DOI: 10.21320/1818-474X-2020-3-88-94
14. Karvouniaris M., Makris D., Zygoulis P., Triantaris A., Xitsas S., Mantzarlis K., et al. Nebulised colistin for ventilator-associated pneumonia prevention. Eur Respir J. 2015;46(6):1732–9. DOI: 10.1183/13993003.02235-2014
15. Wunderink R.G. POINT: Should inhaled antibiotic therapy be used routinely for the treatment of bacterial lower respiratory tract infections in the ICU setting? Yes. Chest. 2017;151(4):737–9. DOI: 10.1016/j.chest.2016.11.006
Review
For citations:
Sakharov V.I., Mironov P.I., Ruslykova I.A., Lutfarakhmanov I.I. Inhaled Polymyxin in Treatment of Elderly Patients with Severe Community-Acquired Klebsiella pneumoniae-Induced Pneumonia. Creative surgery and oncology. 2020;10(4):275-280. (In Russ.) https://doi.org/10.24060/2076-3093-2020-10-4-275-280
Views:
1472
Email this article 