Case ReportSalvage treatment of pneumonia and initial treatment of tracheobronchitis caused by multidrug-resistant Gram-negative bacilli with inhaled polymyxin B
Section snippets
Methods
A total of 19 patients over a 3-year period (July 2002 through June 2005) with respiratory tract infections caused by MR-GNB were treated with aerosolized polymyxin B. The patients were hospitalized at the São Luiz Hospital, São Paulo, Brazil, a private general hospital with 178 beds of which 24 are located in the intensive care unit (ICU), 8 in the pediatric ICU, and 17 in the semiintensive care unit.
The patients were included if they met the criteria for pneumonia or tracheobronchitis
Results
Nineteen patients were treated: 14 with pneumonia (11 ventilator associated) and 5 with tracheobronchitis. The agents were P. aeruginosa (16 patients, 84%), Klebsiella pneumoniae (1 case), Alcaligenes xylosoxidans (1 case), and Burkholderia sp. (1 case). All the patients had received previous antibiotics. The main characteristics of the patient population can be seen in Table 1, and details on each patient are presented in Table 2. Most patients were severely ill (89% were in intensive care)
Discussion
The use of inhaled polymyxin B was started after failure with intravenous in most of our cases of nosocomial pneumonia caused by resistant Gram-negative bacilli, and it led to the improvement or cure in 13 (93%) of 14 cases. All the patients with tracheobronchitis presented a good outcome. Although in the cases of pneumonia, inhalation was given together with intravenous polymyxin B; in the cases of tracheobronchitis, inhalation was used alone. The treatment of respiratory infections caused by
Acknowledgment
Marjorie Shafferman for reviewing the manuscript.
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