الفهرس 
VENTILATOR ASSOCIATED PNEUMONIAOnly 14 pages are availabe for public view
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Abstract
Patients in the intensive care unit (ICU) are at risk for dying
not only from their critical illness but also from secondary
processes such as nosocomial infection. VAP is considered one
of the common causes of this nosocomial infection and a cause
for high morbidity and mortality in ICU. Hospital acquired
pneumonia (HAP) accounts for up to 25% of all ICU infections
and for more than 50% of the antibiotics prescribed. VAP
occurs in 9–27% of all intubated patients In ICU patients,
nearly 90% of episodes of HAP occur during mechanical
ventilation.
In the last 15 years, intensivists, and infectious diseases
consultants have started to face novel peculiar challenges in the
treatment of severe infections in critically ill patients in
intensive care units (ICU), due to the selection and diffusion of
multidrug-resistant Gram-negative bacteria (MDR-GNB).
Indeed, although the development of resistance has
accompanied antimicrobial therapy since its dawn, only in
recent years GNB have started, in non-negligible numbers, to
manifest concomitant resistance to all commonly used classes
of antimicrobials. This has forced clinicians to consider
treatment approaches based on combinations of drugs with
impaired activity, and/or to rediscover old drugs with
suboptimal pharmacokinetics and toxicity issues, all in the
absence of high-level evidence to firmly guide bedside decisions. The development of newer antibiotics has recently
slowed down. This has led to the re-emergence of the ’old
forgotten’ antibiotic ”Colistin”, whose use had almost stopped
(after 1970’s) due to the high incidence of nephrotoxicity and
neurotoxicity. Although colistin is commonly administered
intravenously, it can also be administered via inhalation for
pneumonia/ventilator-associated pneumonia treatment.
The objective of this study is to analyze the efficacy of
nebulized colistin-based monotherapy versus intravenous
administration of colistin in microbiological eradication and
clinical improvement of patients with VAP caused by MDRGNB.
We found that the use of inhaled colistin seems to be
beneficial in therapy of MDR bacilli VAP. Therapeutic
effectiveness of such regimen was as effective as parenteral
colistin. Further, it provided several benefits: a renal safety and
significant bacterial eradication.