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. 2023 May 8;9(2):106-115.
doi: 10.2478/jccm-2023-0012. eCollection 2023 Apr.

Aerosolized Plus Intravenous Polymyxin B Versus Colistin in the Treatment of Pandrug-Resistant Klebsiella Pneumonia-mediated Ventilator-Associated Pneumonia: A Retrospective Cohort Study in Bangladesh

Md Jahidul Hasan  1 , Chandra Datta Sumi  2 , Shihan Mahmud Redwanul Huq  3 , Ahmad Mursel Anam  4 , Raihan Rabbani  3
Affiliations

Aerosolized Plus Intravenous Polymyxin B Versus Colistin in the Treatment of Pandrug-Resistant Klebsiella Pneumonia-mediated Ventilator-Associated Pneumonia: A Retrospective Cohort Study in Bangladesh

Md Jahidul Hasan et al. J Crit Care Med (Targu Mures). .

Abstract

Background: Pandrug-resistant Klebsiella pneumoniae ventilator associated pneumonia (VAP) is associated with high rate of mortality in intensive care unit (ICU) and has been recognized as a difficult-to-treat infection worldwide. Polymyxin B or colistin-based combination therapies are frequently used worldwide though microbial eradication rate is not promising.

Aim: The aim of this study is to compare the clinical outcome of intravenous with aerosolized polymyxin B versus colistin in the treatment of pandrug-resistant K. pneumoniae VAP.

Methods: This retrospective cohort study was conducted on 222 mechanically ventilated patients admitted from May 11, 2019 to October 19, 2020. K. pneumoniae isolates were resistant to all available antibiotics, including polymyxins in culture sensitivity tests. As treatment, polymyxin B and colistin was administered in intravenous and aerosolized form concurrently twice daily in 106 patients and 116 patients in PMB and CLN group, respectively for 14 days. Survival rate, safety, and clinical outcomes were compared among the groups. The Cox proportional-hazard model was performed to calculate hazard ratio (HR) with 95% confidence intervals (CI).

Results: Patients in PMB group showed more microbial eradication than the patients CLN group [68.1% (n=116)/83% (n=106), respectively; P <0.05). The median day of intubation and ICU stay in PMB group was shorter than that in CLN group [10 (IQR: 9-12.25) vs. 14 (IQR: 11-19), P <0.05; 12 (IQR: 10-14) vs. 15 (IQR: 9-18.5), P=0.072, respectively] with reduced 60-day all-cause mortality rate [15% (n=106) vs. 21.55% (n=116)]. Polymyxin B improved survival compared to colistin (multivariate HR: 0.662; 95% CI=0.359-1.222, P=0.195).

Conclusions: Concurrent administration of intravenous and aerosolized polymyxin B in patients with pandrug-resistant K. pneumoniae-associated VAP revealed better microbial eradication, reduced the length of intubation and ICU stay, and improved survival rate compared to colistin.

Keywords: Klebsiella pneumoniae; aerosolization; colistin; intravenous; polymyxin B; ventilator-associated pneumonia.

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Conflict of interest statement

CONFLICT OF INTEREST No conflict of interest to declare by the authors.

Figures

Fig. 1.
Fig. 1.
Kaplan-Meier survival curve for PMB group (aerosolized plus intravenous polymyxin B) (blue line) and CLN group (aerosolized plus intravenous colistin) (green line). Analysis run using Group (PMB vs CLN) as factor; death as event and time to death as time variable. Multivariate Hazard Ratio (H.R. for death: 0.035; 95% CI=0.007-0.168, P<0.001) is adjusted for baseline characteristics.
See this image and copyright information in PMC

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