A comparative study between effect of combined intravenous and nebulized amikacin versus intravenous amikacin alone in mechanically ventilated patients with ventilator-associated pneumonia (VAP)

Ain-Shams Journal of Anesthesiology - Tập 12 - Trang 1-8 - 2020
Dalia M. El Fawy1, Azza Yousef Ibrahim1, Ahmed Mostafa Mohamed Abdulmageed2, Eman Abo Bakr El Seddek1
1Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
2Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Tóm tắt

Aerosolized antibiotic administration offers the theoretical advantages of achieving high drug concentrations at the infection site together with lower systemic absorption. This study aims to compare the effect of combining nebulized amikacin with intravenous amikacin to the effect of the usual intravenous route alone in the treatment of patients with ventilator-associated pneumonia and its impact on the duration of mechanical ventilation, laboratory, and clinical picture of the patients. This study was carried out on 64 mechanically ventilated patients with Gram-negative VAP. The patients were divided into 2 groups. Group A included 32 patients treated with nebulized amikacin plus IV amikacin, and group B included 32 patients treated with IV amikacin alone. The duration of treatment for both groups was 8 days with a daily assessment of Clinical Pulmonary Infection Score (CPIS) and monitoring of clinical and laboratory parameters. Sputum cultures were obtained thereafter. In our study, the CPIS score and overall ICU mortality were less in the nebulized than in the IV group but the difference failed to be statistically significant. Increase of oxygenation level (Pao2/Fio2 ratio), organism clearance, decrease in serum creatinine level, duration of mechanical ventilation, and length of ICU stay were significantly different in favor of group A than group B. Nebulized and IV amikacin offered better oxygenation, organism clearance, less nephrotoxicity, and less duration of mechanical ventilation and ICU stay than the IV group. Combined and IV routes were comparable regarding the decrease in CPIS score and ICU mortality with no significant difference between them. However, we prefer to use the combined regimen for the mentioned reasons. Further large-scale studies are required to confirm these findings and to establish a definite conclusion.

Tài liệu tham khảo

American Thoracic Society and Infectious Diseases Society of America (2005) Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 171:388–416. https://doi.org/10.1164/rccm.200405-644ST Ammar MA, Abdalla W (2018) Effect of extended infusion of meropenem and nebulized amikacin on Gram-negative multidrug-resistant ventilator-associated pneumonia. Saudi journal of anaesthesia 12(1):89–94. https://doi.org/10.4103/sja.SJA_148_17 Bercault N, Boulain T (2001) Mortality rate attributable to ventilator-associated nosocomial pneumonia in an adult Intensive Care Unit: a prospective case-control study. Crit Care Med 29:2303–2309. https://doi.org/10.1097/00003246-200112000-00012 Chastre J, Fagon JY (2002) Ventilator-associated pneumonia. Am J Respir Crit Care Med 165:867–903. https://doi.org/10.1164/ajrccm.165.7.2105078 Cook DJ, Walter SD, Cook RJ, Griffith LE, Guyatt GH, Leasa D et al (1998) Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129:433–440. https://doi.org/10.7326/0003-4819-129-6-199809150-00002 Dhand R (2007) Inhalation therapy in invasive and noninvasive mechanical ventilation. Curr Opin Crit. Care 13:27–38. https://doi.org/10.1097/MCC.0b013e328012e022 Hassan NA, Awdallah FF, Abbassi MM, Sabry NA (2018) Nebulized versus IV amikacin as adjunctive antibiotic for hospital and ventilator-acquired pneumonia postcardiac surgeries: a randomized controlled trial. Critical Care Medicine 46(1):45–52. https://doi.org/10.1097/CCM.0000000000002695 Jaruratanasirikul S, Sriwiriyajan S (2003) Comparison of the pharmacodynamics of meropenem in healthy volunteers following administration by intermittent infusion or bolus injection. J Antimicrob Chemother 52:518–521. https://doi.org/10.1093/jac/dkg378 Kofteridis DP, Alexopoulou C, Valachis A et al (2010) Aerosolized plus intravenous colistin versus intravenous colistin alone for the treatment of ventilator-associated pneumonia: a matched case-control study. Clinical Infectious Diseases 51(11):1238–1244. https://doi.org/10.1086/657242 Lu Q, Luo R, Bodin L, Yang J, Zahr N, Aubry A, Golmard JL, Rouby JJ (2012) Efficacy of high-dose nebulized colistin in ventilator-associated pneumonia caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Anesthesiology: The Journal of the American Society of Anesthesiologists 117(6):1335–1347 Lu Q, Yang J, Liu Z, Gutierrez C, Aymard G, Rouby JJ, Nebulized Antibiotics Study Group (2011): Nebulized ceftazidime and amikacin in ventilator-associated pneumonia caused by Pseudomonas aeruginosa. American journal of respiratory and critical care medicine; 184(1):106-115, DOI: https://doi.org/10.1164/rccm.201011-1894OC. Niederman MS, Craven DE, Bonten MJ (2005) American Thoracic Society and the Infectious Diseases Society of America Guidelines: the management of adults with hospital-acquired, ventilator-associated and healthcare-associated pneumonia. Am J Respir. Crit. Care Med 171:388–416 Palmer LB (2009) Aerosolized antibiotics in critically ill ventilated patients. Curr Opin Crit Care 15:413–418. https://doi.org/10.1097/MCC.0b013e328330abcf Safdar N, Dezfulian C, Collard HR, Saint S (2005) Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 33:2184–2193. https://doi.org/10.1097/01.CCM.0000181731.53912.D9 Schurink CA, Van Nieuwenhoven CA, Jacobs JA, Rozenberg-Arska M, Joore HC, Buskens E, Hoepelman AI, Bonten MJ (2004) Clinical pulmonary infection score for ventilator-associated pneumonia: accuracy and inter-observer variability. Intensive Care Med 30(2):217–224. https://doi.org/10.1007/s00134-003-2018-2 Vallés J, Pobo A, García-Esquirol O, Mariscal D, Real J, Fernández R et al (2007) Excess ICU mortality attributable to ventilator-associated pneumonia: the role of early vs. late onset. Intensive Care Med 33:1363–1368 Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH et al (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. EPIC International Advisory Committee. JAMA 274:639–644. https://doi.org/10.1001/jama.1995.03530080055041