, Volume 20, Issue 3, pp 187-192

Prevention of Gram negative noscomial bronchopneumonia by intratracheal colistin in critically ill patients

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Abstract

Objective

To evaluate the efficiency of intratracheal colistin in preventing nosocomial bronchopneumonia (BPN) in the critically ill.

Design

Study evaluating the clinical incidence of nosocomial BPN in 2 groups of critically ill patients who receive or did not receive intratracheal colistin. BPN was assessed clinically in survivors and histologically in nonsurvivors.

Setting

A 14-bed surgical intensive care unit.

Patients

598 consecutive critically ill patients were studied during a prospective non-randomized study over a 40-month period.

Interventions

251 patients — 31 non-survivors and 220 survivors — did not receive intratracheal colistin and 347 — 42 non-survivors and 305 survivors — received intratracheal colistin for a 2-week period (16000000 units per 24h).

Measurements and results

The incidence of nosocomial BPN was evaluated clinically in survivors, using repeated protected minibronchoalveolar lavages, and histologically in non-survivors via an immediate postmortem pneumonectomy (histologic and semi-quantitative bacteriologic analysis of one lung). The clinical incidence of nosocomial BPN was of 37% in coli (−) survivors and of 27% in coli (+) survivors (p<0.01). This result was histologically confirmed in non-survivors, where the incidence of histologic BPN was of 61% in coli (−) patients and of 36% in coli (+) patients (p<0.001). Emergence of BPN due to colistin-resistant micro-organisms was not observed. Because colistin was successful in preventing Gram-negative BPN and did not change the absolute number of Gram-positive BPN, the proportion of BPN caused bystaphylococcus species was higher in group coli (+) patients (33% vs 16%). Mortality was not significantly influenced by the administration of colistin.

Conclusion

This study suggests that the administration of intratracheal colistin during a 2-week period significantly reduces the incidence of Gram-negative BPN without creating an increasing number of BPN due to colistin-resistant micro-organism.

Presented in part at the 33th Congrès National d'Anesthésie-Réanimation, Paris, September 20, 1991