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Comparison of Inhaled Colistin With Inhaled Amikacin-Fosfomycin in the Treatment of Ventilator-Associated Pneumonia Caused by Extensively Drug-Resistant (Xdr) Acinetobacter: A Clinical Trial Publisher



Hakamifard A1 ; Rahmani N2 ; Homayouni A3 ; Khorvash F4 ; Abbasi S5 ; Ataei B1
Authors
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Authors Affiliations
  1. 1. Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Goldaru Herbal Pharmaceutical Laboratories, Department of Pharmaceutics, School of Pharmacy, Isfahan University of Medical sciences, Isfahan, Iran
  4. 4. Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5. Nosocomial Infection Research Center, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Source: Archives of Clinical Infectious Diseases Published:2021


Abstract

Background: This study aimed to compare the effects of inhaled colistin and inhaled amikacin-fosfomycin combination in the treatment of ventilator-associated pneumonia (VAP) caused by extensively drug-resistant (XDR) Acinetobacter. This clinical trial is the first study to evaluate the effect of inhaled fosfomycin on VAP in Iran. Methods: In this clinical trial, 60 patients with Acinetobacter VAP were divided into two groups of 30 patients. The empirical regimen changed to meropenem plus intravenous colistin in both groups. Inhaled colistin in the first group and inhaled amikacinfosfomycin in the second group were added to the intravenous therapy. Next, the mortality rate, if any, duration of treatment success, and patient withdrawal from VAP were evaluated in the two groups. Results: Although the mean clinical pulmonary infection score (CPIS) before treatment was not significantly different between the two groups, the mean score of the amikacin-fosfomycin group was significantly lower at 72 hours and seven days after the onset of treatment and at the end of treatment. Based on the intra-group assessments, the CPIS in both groups was significantly reduced (P < 0.001). Also, in the inter-group assessments, the mean CPIS changes were significantly different between the two groups, and in the amikacin-fosfomycin group, a greater reduction in the CPIS was observed (P = 0.007). Conclusions: The findings of the present study showed that the use of amikacin-fosfomycin nebulization could lead to increased recovery and reduced treatment duration in patients with VAP, caused by drug-resistant Acinetobacter baumannii. © 2021, Author(s).
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