Evaluation of Safety and Efficacy of Inhaling Colistin in Patients with VAP: A Comprehensive Systematic Review

Introduction: The Incidence of VAP caused by Multidrug-resistant (MDR) gram-negative bacteria (GNB)—particularly Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumonia—is increasing. Colistin (colistimethate sodium) is an essential polymyxin, which has favorableactivity against MDR-GNB., The polycationic/hydrophilic structure of intravenous Colistin when administered through the intravenous route, limits its penetration in lung parenchyma and resulting in systemic toxicity. Therefore, conducting a systematic review to investigate published evidence regarding the safety and efficacy of inhaling Colistin has a clinical significance. Methods: PubMed, Scopus, Cochrane, and Embase databases were searched with MESH words of Ventilator-associated pneumonia or VAP , and Colistin or colistimethate sodium or CMS , and inhaled or aerosolized or nebulized to identify and screen potentially eligible articles for inclusion in the review. Results and Discussion: Out of the initially identified articles, three studies (351 patients with ventilator-associated pneumonia) were included: 3 randomized controlled trials (RCT) examined patients with VAP. In all reviews, Pseudomonas aeruginosa and Acinetobacter baumannii were MDR pathogens which causedinfection. The mean daily dose of inhaled Colistin ranged between 8.8 to 12 MIU. The mean duration of Colistin treatment varied from 5 to 14 days. Inhaled Colistin was as effective as intravenous Colistin in the therapy of MDR bacilli VAP. Improvement of oxygenation and faster bacterial eradication time were shown in all included studies. Besides, systemic antibiotic therapy was different among studies, so it was difficultto evaluate the effect of the co-administered antibiotics on the outcomes. Conclusion: More research on this topic needs to be undertaken due to better clinical and microbiological outcomes of patients receiving inhaled Colistin.

کلیدواژه ها:

Ventilator-associated pneumonia ، VAP ، Colistin ، Aerosolized ،