Science and Research

Global survey on nebulization of antimicrobial agents in mechanically ventilated patients: a call for international guidelines

Nebulized antimicrobial agents are increasingly administered for treatment of respiratory infections in mechanically ventilated (MV) patients. A structured online questionnaire assessing the indications, dosages and recent patterns of use for nebulized antimicrobial agents in MV patients was developed. The questionnaire was distributed worldwide and completed by 192 intensive care units. The most common indications for using nebulized antimicrobial agent were ventilator-associated tracheobronchitis (VAT; 58/87), ventilator-associated pneumonia (VAP; 56/87) and management of multidrug-resistant, Gram-negative (67/87) bacilli in the respiratory tract. The most common prescribed nebulized agents were colistin methanesulfonate and sulfate (36/87, 41.3% and 24/87, 27.5%), tobramycin (32/87, 36.7%) and amikacin (23/87, 26.4%). Colistin methanesulfonate, amikacin and tobramycin daily doses for VAP were significantly higher than for VAT (p < 0.05). Combination of parenteral and nebulized antibiotics occurred in 50 (86%) of 58 prescriptions for VAP and 36 (64.2%) of 56 of prescriptions for VAT. The use of nebulized antimicrobial agents in MV patients is common. There is marked heterogeneity in clinical practice, with significantly different in use between patients with VAP and VAT. Randomized controlled clinical trials and international guidance on indications, dosing and antibiotic combinations to improve clinical outcomes are urgently required.
  • Sole-Lleonart, C.; Roberts, J. A.; Chastre, J.; Poulakou, G.; Palmer, L. B.; Blot, S.; Felton, T.; Bassetti, M.; Luyt, C. E.; Pereira, J. M.; Riera, J.; Welte, T.; Qiu, H.; Rouby, J. J.; Rello, J.; Esgcip Investigators

Keywords

  • Aerosols/*administration & dosage
  • Anti-Infective Agents/*administration & dosage
  • Drug Therapy/standards
  • Global Health
  • Guidelines as Topic
  • Humans
  • *Respiration, Artificial
  • Respiratory Tract Infections/*drug therapy
  • Surveys and Questionnaires
  • Treatment Outcome
  • Colistin
  • dosage
  • mechanical ventilated
  • nebulized antibiotics
  • pulmonary infections
Publication details
DOI: 10.1016/j.cmi.2015.12.016
Journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
Pages: 359-64 
Number: 4
Work Type: Original
Location: BREATH
Disease Area: PH
Partner / Member: MHH
Access-Number: 26723563
See publication on PubMed

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