Effectiveness of adjunctive nebulized antibiotics in critically ill patients with respiratory tract infections.
Administration, Inhalation
Administration, Intravenous
Aged
Aged, 80 and over
Anti-Bacterial Agents
/ administration & dosage
Calcitonin Gene-Related Peptide
/ blood
Critical Illness
Drug Administration Routes
Female
Humans
Kidney
/ drug effects
Kidney Function Tests
Length of Stay
Male
Middle Aged
Nebulizers and Vaporizers
Respiration, Artificial
Respiratory Tract Infections
/ drug therapy
Retrospective Studies
Treatment Outcome
Antiinfective agent
Antimicrobial agent
Critical care
Critically ill
Inhalation
Nebulizer
Respiratory infection
Journal
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
ISSN: 1435-4373
Titre abrégé: Eur J Clin Microbiol Infect Dis
Pays: Germany
ID NLM: 8804297
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
07
07
2019
accepted:
02
10
2019
pubmed:
18
11
2019
medline:
21
10
2020
entrez:
18
11
2019
Statut:
ppublish
Résumé
The purpose of the study was to analyze the effectiveness of adding nebulized antibiotics to systemic antimicrobials in critically ill patients with respiratory tract infections (pneumonia or tracheobronchitis) and the effect on renal function. A retrospective observational cohort study including critically ill patients with respiratory tract infections during a 2-year period was conducted. Intervention group included patients that received nebulized and systemic antimicrobials. Patients in the control group received only systemic antimicrobials. Clinical resolution was the primary endpoint. Secondary outcomes included change in fever, inflammatory parameters, and creatinine clearance; length of hospital stay, systemic therapy, and mechanical ventilation; hospital readmission; and mortality. Regression models were performed to estimate the effect of nebulized antibiotics on outcome variables adjusted by potential confounders. A total of 136 patients were included (93 in control group and 43 in intervention group). The intervention group had higher odds of clinical resolution (adjusted odds ratio (OR): 7.1; 95% confidence interval (95% CI): 1.2, 43.3). Nebulized antibiotic therapy was independently associated with reduction in procalcitonin (adjusted OR: 12.4; 95% CI: 1.4, 109.7). There were no significant differences in the rest of the secondary outcomes or in creatinine clearance reduction. Adding nebulized antibiotics for the management of respiratory tract infections has a positive impact on clinical resolution without increasing the risk of renal toxicity.
Identifiants
pubmed: 31734797
doi: 10.1007/s10096-019-03733-6
pii: 10.1007/s10096-019-03733-6
pmc: PMC7223945
doi:
Substances chimiques
Anti-Bacterial Agents
0
Calcitonin Gene-Related Peptide
JHB2QIZ69Z
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
361-368Références
Palmer LB (2017) Inhaled antibiotics for ventilator-associated infections. Infect Dis Clin N Am 31:577–591. https://doi.org/10.1016/j.idc.2017.05.006
doi: 10.1016/j.idc.2017.05.006
Bassetti M, Luyt CE, Nicolau DP, Pugin J (2016) Characteristics of an ideal nebulized antibiotic for the treatment of pneumonia in the intubated patient. Ann Intensive Care 6:35. https://doi.org/10.1186/s13613-016-0140-x
doi: 10.1186/s13613-016-0140-x
pubmed: 27090532
pmcid: 4835402
Yang JW, Fan LC, Lu HW, Miao XY, Mao B, Xu JF (2016) Efficacy and safety of long-term inhaled antibiotic for patients with non-cystic fibrosis bronchiectasis: a meta-analysis. Clin Respir J 10:731–739. https://doi.org/10.1111/crj.12278
doi: 10.1111/crj.12278
pubmed: 25620629
Michalopoulos AS, Falagas ME (2014) Inhaled antibiotics in mechanically ventilated patients. Minerva Anestesiol 80:236–244
pubmed: 24107830
Rello J, Rouby JJ, Sole-Lleonart C, Chastre J, Blot S, Luyt CE, Riera J, Vos MC, Monsel A, Dhanani J, Roberts JA (2017) Key considerations on nebulisation of antimicrobial agents to mechanically ventilated patients. Clin Microbiol Infect 23:640–646. https://doi.org/10.1016/j.cmi.2017.03.018
doi: 10.1016/j.cmi.2017.03.018
pubmed: 28347790
Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, Napolitano LM, O'Grady NP, Bartlett JG, Carratalà J, El Solh AA, Ewig S, Fey PD, File TM Jr, Restrepo MI, Roberts JA, Waterer GW, Cruse P, Knight SL, Brozek JL (2016) 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 63:e61–e111. https://doi.org/10.1093/cid/ciw353
doi: 10.1093/cid/ciw353
pubmed: 4981759
pmcid: 4981759
Rello J, Solé-Lleonart C, Rouby JJ, Chastre J, Blot S, Poulakou G, Luyt CE, Riera J, Palmer LB, Pereira JM, Felton T, Dhanani J, Bassetti M, Welte T, Roberts JA (2017) 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 23:629–639. https://doi.org/10.1016/j.cmi.2017.04.011
doi: 10.1016/j.cmi.2017.04.011
pubmed: 28412382
Brodt AM, Stovold E, Zhang L (2014) Inhaled antibiotics for stable non-cystic fibrosis bronchiectasis: a systematic review. Eur Respir J 44:382–393. https://doi.org/10.1183/09031936.00018414
doi: 10.1183/09031936.00018414
pubmed: 24925920
Sugianto TD, Chan HK (2016) Inhaled antibiotics in the treatment of non-cystic fibrosis bronchiectasis: clinical and drug delivery perspectives. Expert Opin Drug Deliv 13:7–22. https://doi.org/10.1517/17425247.2015.1078309
doi: 10.1517/17425247.2015.1078309
pubmed: 26289675
Orriols R, Hernando R, Ferrer A, Terradas S, Montoro B (2015) Eradication therapy against Pseudomonas aeruginosa in non-cystic fibrosis bronchiectasis. Respiration 90:299–305. https://doi.org/10.1159/000438490
doi: 10.1159/000438490
pubmed: 26340658
Solé-Lleonart C, Rouby JJ, Blot S, Poulakou G, Chastre J, Palmer LB, Bassetti M, Luyt CE, Pereira JM, Riera J, Felton T, Dhanani J, Welte T, Garcia-Alamino JM, Roberts JA, Rello J (2017) Nebulization of antiinfective agents in invasively mechanically ventilated adults: a systematic review and meta-analysis. Anesthesiology 126:890–908. https://doi.org/10.1097/ALN.0000000000001570
doi: 10.1097/ALN.0000000000001570
pubmed: 28248714
Zampieri FG, Nassar AP Jr, Gusmao-Flores D, Taniguchi LU, Torres A, Ranzani OT (2015) Nebulized antibiotics for ventilator-associated pneumonia: a systematic review and meta-analysis. Crit Care 19:150. https://doi.org/10.1186/s13054-015-0868-y
doi: 10.1186/s13054-015-0868-y
pubmed: 25887226
pmcid: 4403838
Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41. https://doi.org/10.1159/000180580
doi: 10.1159/000180580
pubmed: 1244564
Palmer LB, Smaldone GC (2014) Reduction of bacterial resistance with inhaled antibiotics in the intensive care unit. Am J Respir Crit Care Med 189:1225–1233. https://doi.org/10.1164/rccm.201312-2161OC
doi: 10.1164/rccm.201312-2161OC
pubmed: 24646034
Alves J, Alp E, Koulenti D, Zhang Z, Ehrmann S, Blot S, Bassetti M, Conway-Morris A, Reina R, Teran E, Sole-Lleonart C, Ruiz-Rodríguez M, Rello J, SANEME-2 Investigators (2018) Nebulization of antimicrobial agents in mechanically ventilated adults in 2017: an international cross-sectional survey. Eur J Clin Microbiol Infect Dis 37:785–794. https://doi.org/10.1007/s10096-017-3175-5
doi: 10.1007/s10096-017-3175-5
pubmed: 29318460
Solé-Lleonart C, Rouby JJ, Chastre J, Poulakou G, Palmer LB, Blot S, Felton T, Bassetti M, Luyt CE, Pereira JM, Riera J, Welte T, Roberts JA, Rello J (2016) Intratracheal administration of antimicrobial agents in mechanically ventilated adults: an international survey on delivery practices and safety. Respir Care 61:1008–1014. https://doi.org/10.4187/respcare.04519
doi: 10.4187/respcare.04519
pubmed: 26957647