Table 8.
Microbiological response to aerosolized antibiotics
| Authors | Year | Setting | Design | Indication | Method of Aerosolization; Drug | No of Patients | No of Patients on Systemic Antibiotic Use | No of Organisms in Patients | No of Patients with Eradication of Causative Organism | No of Patients with Resistant Organisms |
|---|---|---|---|---|---|---|---|---|---|---|
| Michalopoulos et al117 | 2005 | ICU, Greece | Retrospective chart review | VAP for 6 patients, HAP for 2 patients | Aerosolized via Siemens Servo Ventilator; colistin | 8 | 7/8 | Acinetobacter, 7; Pseudomonas, 1 | 4/5 | None |
| Kwa et al118 | 2005 | ICU, Singapore | Retrospective chart review | VAP | Aerosolized colistin; no data on method | 21 | Yes, but not active against causative organism | Acinetobacter, 17; Pseudomonas, 4 | 11/11 available cultures | Not described |
| Berlana et al119 | 2005 | ICU, Spain | Retrospective chart review | Pulmonary infection | Aerosolized with various compressors; colistin | 71 | 78% of patients | Acinetobacter, 60; Pseudomonas, 11 | Acinetobacter, 33/33; Pseudomonas, 4/7 | Not described |
| Michalopoulos et al120 | 2008 | ICU, Greece | Prospective | VAP | Aerosolized via Siemens Servo Ventilator; colistin | 60 | 57 | Acinetobacter, 37; Pseudomonas, 12; Klebsiella, 11 | 50/60 | Not described |
| Palmer et al65 | 2008 | ICU, United States | Randomized, double-blind, placebo-controlled | VAT≥2 mL sputum produced over 4 h and organisms on Gram stain | AeroTech jet nebulizer; vancomycin and/or gentamicin | 24, placebo; 19, AA | 32/43 | Multiple species of gram-negative and gram-positive organisms | Placebo, 19; aerosolized, 17 | Placebo (8/24), AA (0/19) |
| Kofteridis et al121 | 2010 | ICU, Greece | Retrospective review, matched case control | VAP | Aerosolized colistin; no details on method | 43 IV and aerosolized colistin; 43 IV colistin | All patients | Acinetobacter, 66; Klebsiella, 12; Pseudomonas, 8 | Placebo, 17 (50%); aerosolized, 19 (45%) | Not described |
| Korbila et al122 | 2010 | ICU, Greece | Retrospective review, matched case control | VAP | Aerosolized via Siemens Servo Ventilator; colistin | 43 IV colistin; 78 aerosolized and IV colistin | All patients | MDR gram-negative organisms | Placebo, 26 (60.5%); aerosolized, 62 (79.5%) |
Not described |
Abbreviations: AA, aerosolized antibiotic; IV, intravenous; VAT, ventilator-associated tracheobronchitis.
From Palmer LB. Aerosolized antibiotics in the intensive care unit. Clin Chest Med 2011;32:559–74; with permission.