Clinical efficacy and safety of intravenous colistin sulfate monotherapy versus combination with nebulized inhalation for pulmonary infections caused by carbapenem-resistant gram-negative bacilli: a multicenter retrospective cohort study.
10.3760/cma.j.cn121430-20240401-00300
- Author:
Danyang PENG
1
;
Fan ZHANG
1
;
Ying LIU
2
;
Yanqiu GAO
3
;
Lanjuan XU
3
;
Xiaohui LI
4
;
Suping GUO
4
;
Lihui WANG
5
;
Lin GUO
6
;
Yonghai FENG
7
;
Chao QIN
7
;
Huaibin HAN
8
;
Xisheng ZHENG
9
;
Faming HE
10
;
Xiaozhao LI
10
;
Bingyu QIN
1
;
Huanzhang SHAO
1
Author Information
1. Department of Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China.
2. Department of Critical Care Medicine, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.
3. Department of Critical Care Medicine, Zhengzhou Central Hospital, Zhengzhou 450000, China.
4. Department of Critical Care Medicine, Fuwai Central China Cardiovascular Hospital, Zhengzhou 450000, China.
5. Department of Critical Care Medicine, Henan Provincial Hospital of Traditional Chinese Medicine, Zhengzhou 450000, China.
6. Department of Critical Care Medicine, Zhengzhou Seventh People's Hospital, Zhengzhou 450000, China.
7. Department of Critical Care Medicine, the Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China.
8. Department of Critical Care Medicine, Zhoukou Central Hospital, Zhoukou 466000, China.
9. Department of Critical Care Medicine, Nanyang Central Hospital, Nanyang 473000, China.
10. Department of Critical Care Medicine, Henan Provincial Chest Hospital, Zhengzhou 450003, China. Corresponding author: Shao Huanzhang, Email: shaohuanzhang@sina.com.
- Publication Type:English Abstract
- MeSH:
Humans;
Colistin/therapeutic use*;
Retrospective Studies;
Administration, Inhalation;
Anti-Bacterial Agents/therapeutic use*;
Carbapenems/pharmacology*;
Male;
Female;
Middle Aged;
Gram-Negative Bacteria/drug effects*;
Aged;
Treatment Outcome;
Respiratory Tract Infections/drug therapy*
- From:
Chinese Critical Care Medicine
2025;37(9):829-834
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO).
METHODS:A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed.
RESULTS:A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×109/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups.
CONCLUSIONS:Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
