910. Inhaled Colistin as Treatment for Patients With Multidrug Resistant Gram Negative Bacterial Pneumonia and Tracheobronchitis
Session: Poster Abstract Session: Respiratory Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Respiratory infections with multi-drug resistant (MDR) gram negative bacteria is on the rise resulting in an increased use of inhaled colistin. The aim of our study was to retrospectively evaluate the safety and outcome of colistin treatment in Cystic Fibrosis (CF) and non-CF patients with airway MDR bacterial tracheobronchitis and pneumonia.

Methods: We reviewed the charts of all patients admitted to CHLA between January 1, 2005 and December 31, 2012 who received inhaled colistin as treatment for MDR bacterial tracheobronchitis and pneumonia.

Results: A total of 49 patients received inhaled colistin. Twenty nine (59%) patients received the drug for suppressive therapy and were excluded. The remaining 20 (40.8%) patients who received inhaled colistin as treatment for MDR airway bacterial infection were analyzed. Twelve (60%) patients had the diagnosis of CF and eight (40%) patients had other underlying diseases (prematurity, Prune Belly syndrome, Brachman De Lange syndrome, Microvillus inclusion disease, dwarfism, developmental delay, lymphoma, leukemia). Pathogens isolated from respiratory cultures included Pseudomonas aeruginosa (n=15), Acinetobacter baumanii (n=2), Burkholderia Cepacia (n=2), and Achromobacter xylosoxidans (n=1). Fourteen (70%) patients received inhaled colistin as adjunctive therapy for  MDR bacteria, and 6 (30%) patients received colistin following failure to improve on other antimicrobials. Patients received 75 mg to 150 mg dosages, given as nebulized treatments twice daily. Duration of treatment ranged from 3 to 41 days with a mean of 13.8 days. There were no adverse events, including bronchospasm, documented with use of inhaled colistin. Sixteen (80%) patients showed improvement. Of those, 8 patients had negative repeat respiratory cultures, 5 had improved pulmonary function tests and 3 had decrease in oxygen requirement with improvement in respiratory status. One patient had negative repeat respiratory culture, but died due to multi-organ failure. Three (15%) patients died of respiratory failure during the episode  with persistent growth of MDR bacteria.

Conclusion: This study shows that inhaled colistin is safe and might improve the outcome of patients with MDR gram negative bacterial tracheobronchitis and pneumonia.

Diala Faddoul, MD, Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, CA, Michael Ta, BS, Pharmacy, Pacific University of Oregon, Eugene, OR, Melanie George, Pharmacy, Children's Hospital Los Angeles, Los Angeles, CA and Pia Pannaraj, MD, MPH, Division of Infectious Diseases, Children's Hospital Los Angeles, Los Angeles, CA


D. Faddoul, None

M. Ta, None

M. George, None

P. Pannaraj, None

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