Prevention of Gram negative noscomial bronchopneumonia by intratracheal colistin in critically ill patients
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To evaluate the efficiency of intratracheal colistin in preventing nosocomial bronchopneumonia (BPN) in the critically ill.
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.
A 14-bed surgical intensive care unit.
598 consecutive critically ill patients were studied during a prospective non-randomized study over a 40-month period.
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.
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.
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- Prevention of Gram negative noscomial bronchopneumonia by intratracheal colistin in critically ill patients
Intensive Care Medicine
Volume 20, Issue 3 , pp 187-192
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- Nosocomial bronchopneumonia
- Mechanical ventilation
- Intratracheal colistin
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- Author Affiliations
- 1. Unité de Réanimation Chirurgicale, Département d'Anesthésie, Laboratoire d'Anatomo-Pathologie et Laboratoire de Bactériologie, Hôpital de la Pitié-Salpétrière, Université Paris VI, 83 boulevard de l'Hôpital, F-75651, Paris Cedex 13, France