High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A Review
Hospital-acquired pneumonia, including ventilator-associated pneumonia (VAP) due to difficult-to-treat-resistant (DTR) Gram-negative bacteria, contributes significantly to morbidity and mortality in ICUs. In the era of COVID-19, the incidences of secondary nosocomial pneumonia and the demand for inv...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-05-01
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| Series: | Microorganisms |
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| Online Access: | https://www.mdpi.com/2076-2607/11/6/1459 |
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| author | Ilias Karaiskos Aikaterini Gkoufa Elena Polyzou Georgios Schinas Zoe Athanassa Karolina Akinosoglou |
| author_facet | Ilias Karaiskos Aikaterini Gkoufa Elena Polyzou Georgios Schinas Zoe Athanassa Karolina Akinosoglou |
| author_sort | Ilias Karaiskos |
| collection | DOAJ |
| description | Hospital-acquired pneumonia, including ventilator-associated pneumonia (VAP) due to difficult-to-treat-resistant (DTR) Gram-negative bacteria, contributes significantly to morbidity and mortality in ICUs. In the era of COVID-19, the incidences of secondary nosocomial pneumonia and the demand for invasive mechanical ventilation have increased dramatically with extremely high attributable mortality. Treatment options for DTR pathogens are limited. Therefore, an increased interest in high-dose nebulized colistin methanesulfonate (CMS), defined as a nebulized dose above 6 million IU (MIU), has come into sight. Herein, the authors present the available modern knowledge regarding high-dose nebulized CMS and current information on pharmacokinetics, clinical studies, and toxicity issues. A brief report on types of nebulizers is also analyzed. High-dose nebulized CMS was administrated as an adjunctive and substitutive strategy. High-dose nebulized CMS up to 15 MIU was attributed with a clinical outcome of 63%. High-dose nebulized CMS administration offers advantages in terms of efficacy against DTR Gram-negative bacteria, a favorable safety profile, and improved pharmacokinetics in the treatment of VAP. However, due to the heterogeneity of studies and small sample population, the apparent benefit in clinical outcomes must be proven in large-scale trials to lead to the optimal use of high-dose nebulized CMS. |
| first_indexed | 2024-03-11T02:08:08Z |
| format | Article |
| id | doaj.art-42a984c7384c49dd983639230abc755f |
| institution | Directory Open Access Journal |
| issn | 2076-2607 |
| language | English |
| last_indexed | 2024-03-11T02:08:08Z |
| publishDate | 2023-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Microorganisms |
| spelling | doaj.art-42a984c7384c49dd983639230abc755f2023-11-18T11:42:09ZengMDPI AGMicroorganisms2076-26072023-05-01116145910.3390/microorganisms11061459High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A ReviewIlias Karaiskos0Aikaterini Gkoufa1Elena Polyzou2Georgios Schinas3Zoe Athanassa4Karolina Akinosoglou5First Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4, Erythrou Stavrou Str. & Kifisias, 15123 Athens, GreeceInfectious Diseases and COVID-19 Unit, Medical School, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, GreeceSchool of Medicine, University of Patras, 26504 Patras, GreeceSchool of Medicine, University of Patras, 26504 Patras, GreeceIntensive Care Unit, Sismanoglio General Hospital, 15126 Athens, GreeceSchool of Medicine, University of Patras, 26504 Patras, GreeceHospital-acquired pneumonia, including ventilator-associated pneumonia (VAP) due to difficult-to-treat-resistant (DTR) Gram-negative bacteria, contributes significantly to morbidity and mortality in ICUs. In the era of COVID-19, the incidences of secondary nosocomial pneumonia and the demand for invasive mechanical ventilation have increased dramatically with extremely high attributable mortality. Treatment options for DTR pathogens are limited. Therefore, an increased interest in high-dose nebulized colistin methanesulfonate (CMS), defined as a nebulized dose above 6 million IU (MIU), has come into sight. Herein, the authors present the available modern knowledge regarding high-dose nebulized CMS and current information on pharmacokinetics, clinical studies, and toxicity issues. A brief report on types of nebulizers is also analyzed. High-dose nebulized CMS was administrated as an adjunctive and substitutive strategy. High-dose nebulized CMS up to 15 MIU was attributed with a clinical outcome of 63%. High-dose nebulized CMS administration offers advantages in terms of efficacy against DTR Gram-negative bacteria, a favorable safety profile, and improved pharmacokinetics in the treatment of VAP. However, due to the heterogeneity of studies and small sample population, the apparent benefit in clinical outcomes must be proven in large-scale trials to lead to the optimal use of high-dose nebulized CMS.https://www.mdpi.com/2076-2607/11/6/1459colistin methanesulfonatecolistinhigh-dose nebulized CMSnebulizersclinical efficacytoxicity |
| spellingShingle | Ilias Karaiskos Aikaterini Gkoufa Elena Polyzou Georgios Schinas Zoe Athanassa Karolina Akinosoglou High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A Review Microorganisms colistin methanesulfonate colistin high-dose nebulized CMS nebulizers clinical efficacy toxicity |
| title | High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A Review |
| title_full | High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A Review |
| title_fullStr | High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A Review |
| title_full_unstemmed | High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A Review |
| title_short | High-Dose Nebulized Colistin Methanesulfonate and the Role in Hospital-Acquired Pneumonia Caused by Gram-Negative Bacteria with Difficult-to-Treat Resistance: A Review |
| title_sort | high dose nebulized colistin methanesulfonate and the role in hospital acquired pneumonia caused by gram negative bacteria with difficult to treat resistance a review |
| topic | colistin methanesulfonate colistin high-dose nebulized CMS nebulizers clinical efficacy toxicity |
| url | https://www.mdpi.com/2076-2607/11/6/1459 |
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