Efficacy and Safety of Different Colistin Administration Routes for Nosocomial Pneumonia Caused by Carbapenem-Resistant Organisms: A Single Centre, Open Label, Prospective Cohort Study.
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.
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.
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 failure, suggesting it may serve as a prognostic marker for poor outcomes.
In critically ill patients with CRO-associated NP, inhaled colistin monotherapy provided comparable clinical efficacy to systemic administration. It achieved superior microbiological eradication and showed a favorable safety profile regarding nephrotoxicity, suggesting it represents a viable and potentially safer therapeutic strategy.
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.
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 failure, suggesting it may serve as a prognostic marker for poor outcomes.
In critically ill patients with CRO-associated NP, inhaled colistin monotherapy provided comparable clinical efficacy to systemic administration. It achieved superior microbiological eradication and showed a favorable safety profile regarding nephrotoxicity, suggesting it represents a viable and potentially safer therapeutic strategy.