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Open Access 01-12-2022 | Septic Shock | Research

Low-dose intravenous plus inhaled versus intravenous polymyxin B for the treatment of extensive drug-resistant Gram-negative ventilator-associated pneumonia in the critical illnesses: a multi-center matched case–control study

Authors: Jiao Liu, Min Shao, Qianghong Xu, Fen Liu, Xiaojun Pan, Jianfeng Wu, Lihong Xiong, Yueming Wu, Mi Tian, Jianying Yao, Sisi Huang, Lidi Zhang, Yizhu Chen, Sheng Zhang, Zhenliang Wen, Hangxiang Du, TaoWang, Yongan Liu, Wenzhe Li, Yan Xu, Jean-louis Teboul, Dechang Chen

Published in: Annals of Intensive Care | Issue 1/2022

Abstract

Background

The mortality of extensively drug-resistant Gram-negative (XDR GN) bacilli-induced ventilator-associated pneumonia (VAP) is extremely high. The purpose of this study was to compare the efficacy and safety of inhaled (IH) plus intravenous (IV) polymyxin B versus IV polymyxin B in XDR GN bacilli VAP patients.

Methods

A retrospective multi-center observational cohort study was performed at eight ICUs between January 1^st 2018, and January 1^st 2020 in China. Data from all patients treated with polymyxin B for a microbiologically confirmed VAP were analyzed. The primary endpoint was the clinical cure of VAP. The favorable clinical outcome, microbiological outcome, VAP-related mortality and all-cause mortality during hospitalization, and side effects related with polymyxin B were secondary endpoints. Favorable clinical outcome included clinical cure or clinical improvement.

Results

151 patients and 46 patients were treated with IV polymyxin B and IH plus IV polymyxin B, respectively. XDR Klebsiella pneumoniae was the main isolated pathogen (n = 83, 42.1%). After matching on age (± 5 years), gender, septic shock, and Apache II score (± 4 points) when polymyxin B was started, 132 patients were included. 44 patients received simultaneous IH plus IV polymyxin B and 88 patients received IV polymyxin B. The rates of clinical cure (43.2% vs 27.3%, p = 0.066), bacterial eradication (36.4% vs 23.9%, p = 0.132) as well as VAP-related mortality (27.3% vs 34.1%, p = 0.428), all-cause mortality (34.1% vs 42.0%, p = 0.378) did not show any significant difference between the two groups. However, IH plus IV polymyxin B therapy was associated with improved favorable clinical outcome (77.3% vs 58.0%, p = 0.029). Patients in the different subgroups (admitted with medical etiology, infected with XDR K. pneumoniae, without bacteremia, with immunosuppressive status) were with odd ratios (ORs) in favor of the combined therapy. No patient required polymyxin B discontinuation due to adverse events. Additional use of IH polymyxin B (aOR 2.63, 95% CI 1.06, 6.66, p = 0.037) was an independent factor associated with favorable clinical outcome.

Conclusions

The addition of low-dose IH polymyxin B to low-dose IV polymyxin B did not provide efficient clinical cure and bacterial eradication in VAP caused by XDR GN bacilli.

Keypoints

Additional use of IH polymyxin B was the sole independent risk factor of favorable clinical outcome. Patients in the different subgroups were with HRs substantially favoring additional use of IH polymyxin B. No patients required polymyxin B discontinuation due to adverse events.

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Title: Low-dose intravenous plus inhaled versus intravenous polymyxin B for the treatment of extensive drug-resistant Gram-negative ventilator-associated pneumonia in the critical illnesses: a multi-center matched case–control study
Authors: Jiao Liu
Min Shao
Qianghong Xu
Fen Liu
Xiaojun Pan
Jianfeng Wu
Lihong Xiong
Yueming Wu
Mi Tian
Jianying Yao
Sisi Huang
Lidi Zhang
Yizhu Chen
Sheng Zhang
Zhenliang Wen
Hangxiang Du
TaoWang
Yongan Liu
Wenzhe Li
Yan Xu
Jean-louis Teboul
Dechang Chen
Publication date: 01-12-2022
Publisher: Springer International Publishing
Keywords: Septic Shock
Pneumonia
Pseudomonas Aeruginosa
Published in: Annals of Intensive Care / Issue 1/2022
Electronic ISSN: 2110-5820
DOI: https://doi.org/10.1186/s13613-022-01033-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Low-dose intravenous plus inhaled versus intravenous polymyxin B for the treatment of extensive drug-resistant Gram-negative ventilator-associated pneumonia in the critical illnesses: a multi-center matched case–control study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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