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논문 기본 정보

자료유형
학술저널
저자정보
저널정보
한국병원약사회 병원약사회지 병원약사회지 제37권 제1호
발행연도
2020.1
수록면
11 - 19 (9page)

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Background : Multidrug resistant (MDR) Acinetobacter baumannii (A. baumannii) and Pseudomonas aeruginosa (P. aeruginosa) have emerged as major pathogens of pneumonia in the intensive care unit (ICU). Colistin is used as a drug of choice against pneumonia caused by these pathogens, but when it is administrated systemically, adverse effects such as renal toxicity and neurotoxicity limit its application. Recently, nebulized treatment of colistin has been widely applied to reduce these adverse effects, but the clinical data of nebulized colistin has been limited. The purpose of this study was to compare the efficacy and safety of nebulized colistin with intravenous colistin. Methods : A retrospective medical records review was conducted on patients admitted to the ICUs at a teaching hospital. The patients were diagnosed with pneumonia caused by MDR A. baumanniior P. aeruginosa and treated with colistin either by intravascular or nebulized form August 2015-July 2016. Results : This study included 88 patients, of whom 29 received intravenous colisitin (IV group), and 59 nebulized colistin (Neb group). The mean duration of treatment was 14.8 days in the IV group and 15.8 days in the Neb group (p=0.604). The success rate of treatment based on clinical response and negative conversion rate were not different between the two groups (58.6% vs. 54.2%, OR 0.84, 95% CI 0.34-2.06, p=0.697, respectively). The number of patients whose white blood cell count recovered to normal range during or after colistin treatment was significantly larger in the Neb group than the IV group (55.9% vs. 41.4%, OR 3.77, 95% CI 1.55-9.15, P=0.003, respectively). The negative conversion rate was not different between the two groups (41.4% vs. 37.3%, OR 0.84, 95% CI 0.34- 2.09, p=0.711, respectively). The serum creatinine difference before and after the colistin treatment was significantly greater in the IV group than in the Neb group (0.48±0.17 vs. 0.01±0.11, p=0.016). The acute kidney injury (AKI) incidence rate was also significantly higher in the IV group than the Neb group (62.1% vs. 23.7%, p<0.001, respectively). Conclusion : The efficacy of nebulized colistin was similar with intravenous colistin for ICU patients with pneumonia caused by MDR A. baumannii or P. aeruginosa. Also, nebulized colistin showed favorable results in serum creatinine change and the AKI incidence rate.

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참고문헌 (20)

참고문헌 신청
Maragakis LL / 2008 / Acinetobacter baumannii : epidemiology, antimicrobial resistance, and treatment options / Clin Infect Dis 46(8):1254~1263 google schola Aloush V / 2006 / Multidrug-resistant Pseudomonas aeruginosa : risk factors and clinical impact / Antimicrob Agents Chemother 50(1):43~48 google schola Paterson DL / 2006 / The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species / Clinical infectious diseases 43(Supplement 2):43~48 google schola Playford EG / 2007 / Carbapenem-resistant Acinetobacter baumannii in intensive care unit patients:risk factors for acquisition, infection and their consequences / J Hosp Infect 65(3):204~211 google schola Navon-Venezia S / 2005 / Update on Pseudomonas aeruginosa and Acinetobacter baumannii infections in the healthcare setting / Current opinion in infectious diseases 18(4):306~313 google schola

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