Intensive Care Medicine

, Volume 35, Issue 10, pp 1792–1800

Nebulized ceftazidime in experimental pneumonia caused by partially resistant Pseudomonas aeruginosa

Authors

  • Fabio Ferrari
    • Réanimation Polyvalente Pierre Viars, Département d’Anesthésie-RéanimationUPMC Univ Paris 06, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris
    • Polyvalent Intensive Care Unit Pierre Viars, La Pitié-Salpêtrière HospitalUniversity Pierre et Marie Curie
  • Qin Lu
    • Réanimation Polyvalente Pierre Viars, Département d’Anesthésie-RéanimationUPMC Univ Paris 06, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris
    • Polyvalent Intensive Care Unit Pierre Viars, La Pitié-Salpêtrière HospitalUniversity Pierre et Marie Curie
  • Cassio Girardi
    • Department of AnesthesiologyFederal University of Sao Paulo
  • Olivier Petitjean
    • Department of PharmacologyAvicenne Hospital
  • Charles-Hugo Marquette
    • DHURE and INSERM U 416University of Medicine
  • Frederic Wallet
    • Department of BacteriologyUniversity of Medicine
    • Réanimation Polyvalente Pierre Viars, Département d’Anesthésie-RéanimationUPMC Univ Paris 06, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris
    • Polyvalent Intensive Care Unit Pierre Viars, La Pitié-Salpêtrière HospitalUniversity Pierre et Marie Curie
  • the Experimental ICU Study Group
Experimental

DOI: 10.1007/s00134-009-1605-2

Cite this article as:
Ferrari, F., Lu, Q., Girardi, C. et al. Intensive Care Med (2009) 35: 1792. doi:10.1007/s00134-009-1605-2

Abstract

Purpose

Ventilator-associated pneumonia caused by Pseudomonas aeruginosa with impaired sensitivity to ceftazidime is frequent in critically ill patients. The aim of the study was to compare lung tissue deposition and antibacterial efficiency between nebulized and intravenous administrations of ceftazidime in ventilated piglets with pneumonia caused by Pseudomonas aeruginosa with impaired sensitivity to ceftazidime.

Methods

Ceftazidime was administered 24 h following the intra-bronchial inoculation of Pseudomonas aeruginosa (minimum inhibitory concentration = 16 μg ml−1), either by nebulization (25 mg kg−1 every 3 h, n = 6) or by continuous intravenous infusion (90 mg kg−1 over 24 h after an initial rapid infusion of 30 mg kg−1, n = 6). Four non-treated inoculated animals served as controls. All piglets were killed 48 h (intravenous and control groups) or 51 h (aerosol group) after inoculation. Lung tissue concentrations and lung bacterial burden were assessed on multiple post-mortem sub-pleural lung specimens [(lower limit of quantitation = 102 colony forming unit (cfu g−1)].

Results

Ceftazidime trough lung tissue concentrations following nebulization were greater than steady-state lung tissue concentrations following continuous intravenous infusion [median and interquartile range, 24.8 (12.6–59.6) μg g−1 vs. 6.1 (4.6–10.8) μg g−1] (p < 0.001). After 24 h of ceftazidime administration, 83% of pulmonary segments had bacterial counts <102 cfu g−1 following nebulization and only 30% following intravenous administration (p < 0.001). In control animals, 10% of lung segments had bacterial counts <102 cfu g−1 48 h following bronchial inoculation.

Conclusion

Nebulized ceftazidime provides more efficient bacterial killing in ventilated piglets with pneumonia caused by Pseudomonas aeruginosa with impaired sensitivity to ceftazidime.

Keywords

NebulizationCeftazidimePneumoniaPseudomonas aeruginosaMechanical ventilationTreatment

Copyright information

© Springer-Verlag 2009