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THE EFFECT OF AMIKACIN INHALATION ON THE EFFECTIVENESS OF THE TREATMENT OF VENTILATOR-ASSOCIATED PNEUMONIA AND VENTILATOR-ASSOCIATED TRACHEOBRONCHITIS CAUSED BY MULTIPLE DRUG RESISTANT GRAM-NEGATIVE FLORA. A COMPARATIVE STUDY


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Abstract

The purpose of the study. A comparative evaluation of the clinical and microbiological efficacy of a combination of amikacin given via an Aeroneb Pro nebulizer and a standard antimicrobial therapy (AMTcomb) with a standard antimicrobial therapy (AMTst) in the treatment of ventilator-associated pneumonia (VAP) and ventilator-associated tracheobronchitis (VAT) caused by multiple drug resistant Gram-negative flora. Material and methods. Patients with signs of VAP and VAT were included in a prospective single-center study with a retrospective control (n = 50). In the AMTst group (retrospective) (n = 25), a combination of iv meropenem 1 g once every 8h as a continuous infusion, iv cefoperazon/sulbactam 4 g once every 12 h as a continuous infusion and iv amikacin 1 g once every 24 h was used. In the AMTcomb group (prospective) (n = 25), a combination of the AMTst and amikacin inhalation 500 mg once every 12 h via an Aeroneb Pro nebulizer was used. Results. In the AMTcomb group, the clinical recovery rate was 84% of patients, while in the AMTst group it was in 29.2% of patients (p < 0.001); at that, on day 7, the CPIS scoring was 6 (4-7) in the AMTst group and 2 (0-4) in the AMTcomb group (p < 0.001). The clinical recurrence of VAP/VAT was observed in 29.2% of patients in the AMTst group and 12.5% of patients in the AMTcomb group (p = 0.008). On day 7, the main infectious agent titer in the tracheal aspirate was 107 (103-108) CFU/mL in the AMTst group and 103 (no growth - 106) CFU/mL in the AMTcomb group (p = 0.016). The microbiological eradication was observed in 13 patients in the AMTcomb group vs 1 patient in the AMTst group and the microbiological persistence was observed in 6 patients in the AMTcomb group vs 17 patients in the AMTst group (р = 0.002). On day 3, the bronchial secretion was less pronounced in the AMTcomb group with a predominantly mild secretion rate (n = 23), and none of the patients presented bronchorrhea, while in the AMTst group the secretion of sputum was abundant (n = 13) and 2 patients had bronchorrhea (p < 0.001). In the AMTcomb group, on day 3, sputum was less purulent (p = 0.016): 7 patients had mucin alone; in the AMTst group, mucin was found in none of the patients. Amikacin inhalation did not lead to the deterioration of the organ dysfunction: on day 7, there was no difference in the platelet count, creatinine and total bilirubin levels as compared to the baseline (p = 0.102; p = 0.297 and p = 0.532, respectively). Conclusion. Addition of amikacin inhalation 500 mg once every 12 h via an Aeroneb Pro nebulizer to the treatment of VAP and VAT emhances the efficacy of the treatment without impairment of the organ function.


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