299. Efficacy and Safety of Colistin for the Treatment of Ventilator-Acquired Pneumonia: A Systematic Review and Meta-analysis
Session: Poster Abstract Session: Antimicrobial Therapy: Clinical Studies
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • Colistin-poster 10.4.11.small.pdf (81.1 kB)
  • Background: Intravenous efficacy of colistin for treatment of lung infections has been debated because of poor penetration into the lung parenchyma. Inhaled colistin might be an alternative since the drug achieves high concentration in the respiratory tract while avoiding systemic effects. Experience with either form of colistin for the treatment of ventilator-acquired pneumonia (VAP) in non-cystic fibrosis patients is limited. We aimed to assess the safety and efficacy of colistin for the treatment of VAP.

    Methods: We searched MEDLINE and Cochrane Database of Systematic Reviews for studies comparing colistin vs. other antibiotics for treatment of VAP in non-cystic fibrosis patients. QUOROM guidelines were followed, I2 method was used for heterogeneity, and random-effects model for odds ratio (OR) estimates.

    Results: 6 studies (359 patients, 186 on colistin and 173 on other antibiotics as controls) met the inclusion criteria. Clinical response was not significantly different between colistin and control groups [OR 1.14 (95%CI 0.74, 1.77), p=0.56, I2=0%]. The magnitude of colistin efficacy was non-significantly different by the route of administration: for intravenous (4 studies, 244 patients) OR 1.13 (95%CI 0.66, 1.93; p=0.66, I2=0%), and for nebulized administration (2 studies, 115 patients) OR 3.02 (95%CI 0.18, 51.19, p= 0.44, I2=76.9%). The study design did not influence the efficacy of colistin:  prospective studies (3 studies, 163 patients): OR 0.89 (95%CI 0.48, 1.66, p=0.71, I2=0%), retrospective studies (3 studies, 196 patients): OR  1.45 (95%CI 0.79, 2.68, p=0.23, I2=0%); randomized trials (2 studies, 128 patients): OR 0.86 (95%CI, 0.43, 1.74, p=0.68, I2=0%).  There was no indication of a significant change on clinical response after controlling for concomitant antibiotic treatment for colistin (intercept 0.121, slope 0.0315, p=0.95). Treatment with colistin vs. controls did not differ with respect to hospital mortality (5 studies, 331 patients) OR 0.92 (95%CI 0.50, 1.67, p=0.78, I2=34.59%) or nephrotoxicity (5 studies, 344 patients) OR 1.14 (95%CI 0.59, 2.20, p=0.69, I2=0%).

    Conclusion: Current available evidence suggests that colistin may be as safe and as efficacious as standard antibiotics for the treatment of VAP.


    Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

    Diana F. Florescu, M.D.1, Fang Qiu, MS2, Cezarina Mindru, MD3, Megan McCartan, PharmD, BCPS4, Paul Fey, PhD2 and Andre C. Kalil, MD1, (1)Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (2)University of Nebraska Medical Center, Omaha, NE, (3)Hepatology, University of Nebraska Medical center, Omaha, NE, (4)Nebraska Medical Center, Omaha, NE

    Disclosures:

    D. F. Florescu, None

    F. Qiu, None

    C. Mindru, None

    M. McCartan, None

    P. Fey, None

    A. C. Kalil, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.