Uso de antibióticos nebulizados en pacientes con neumonía asociada al respirador. Revisión de la literatura
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Abstract
El uso sistémico de antibióticos en pacientes con neumonía asociada al respirador (NAR) se considera el tratamiento estándar. El uso de antibióticos nebulizados, sea como monoterapia o, más importante, combinado con los antibióticos endovenosos, han demostrado tener varios beneficios farmacológicos: a) los antibióticos nebulizados alcanzan el parénquima pulmonar sin cruzar la barrera alvéolo capilar; b) los antibióticos nebulizados logran mayor eficacia antibacteriana al alcanzar altas concentraciones locales; y c) los antibióticos nebulizados disminuye la toxicidad sistémica. Estos beneficios son particularmente importante para tratar NAR causadas por organismos multirresistentes. Aún los datos clínicos sobre los beneficios de los antibóticos nebulizados son limitados.
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References
- Guillamet CV, Kollef MH. Ventilator associated pneumonia in the ICU: where has it gone? Curr Opin Pulm Med. 2015;21:226-231
- Guillamet CV, Kollef MH. Update on Ventilator associated pneumonia. Curr Opin Crit Care. 2015;21:430-438
- Bassetti M, Taramasso L, Giacobbe DR, Pelosi P. Management of ventilator-associated pneumonia: epidemiology, diagnosis and antimicrobial therapy. Expert Rev Anti Infect Ther. 2012;10:585-596
- Bekaert M, Timsit JF, Vansteelandt S, Depuydt P, Vésin A, Garrouste-Orgeas M, et al. Outcome Study Group. Attributable mortality of ventilator-associated pneumonia: a reappraisal using causal analysis. Am J Respir Crit Care Med. 2011;184:1133-1139
- Boucher H, Talbot G, Bradley J et al, Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:1–12.
- Bassetti M, De Waele JJ, Eggimann P et al, Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria. Intensive Care Med. 2015;41:776–795.
- Kalil AC, Metersky ML, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61-e111
- Poulakou G, Siakallis G, Tsiodras S, et al. Nebulized antibiotics in mechanically ventilated patients: roadmap and challenges. Expert Rev Anti Infect Ther. 2016 Dec 6. [Epub ahead of print]
- Rodvold K, George JM, Yoo L. Penetration of anti-infective agents into pulmonary epithelial lining fluid: focus on antibacterial agents. Clin. Pharmacokinet. 2011;50:637–664.
- Palmer LB. Ventilator-associated infection: the role for inhaled antibiotics. Curr Opin Pulm Med. 2015;21:239-249.
- Le J, Ashley ED, Neuhauser MM, et al. Consensus Summary of Aerosolized Antimicrobial Agents: Application of Guideline Criteria: Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2010;30:562-584
- Drlica K, Zhao X. Mutant selection window hypothesis updated. Clin Infect Dis. 2007;44:681–688.
- Rouby JJ et al. In: Principles & Practice of Mechanical Ventilation; 2nd edition, 2006. Inhaled Antibiotic Therapy; 1311-1321
- Luyt CE, Combes A, Nieszkowska A, et al. Aerosolized antibiotics to treat ventilator-associated pneumonia. Curr Opin infect Dis 2009;22:154-158.
- Lu Q, Yang J, Liu Z, et al. Nebulized ceftazidime and amikacin in ventilator-associated pneumonia caused by Pseudomonas aeruginosa. Am J Respir Crit Care Med. 2011;184:106-115
- Mojoli F, Iotti GA, Imberti R, et al. The importance of protecting the mechanical ventilator during colistin methanesulfonate nebulization. Intensive Care Med. 2013;39:535-536.
- Dhand R. The role of aerosolized antimicrobials in the treatment of ventilator-associated pneumonia. Respir Care 2007;52:866–884
- Kassamali Z, Rotschafer JC, Jones RN, et al. Polymyxins: wisdom does not always come with age. Clin Infect Dis. 2013;57:877-883.
- Shalini WS, Yapa JL, Kashyap P, et al. Pulmonary and systemic pharmacokinetics of inhaled and intravenous colistin methanesulfonate in cystic fibrosis patients: targeting advantage of inhalational administration. Antimicrob Agents Chemother. 2014;58:2570–2579.
- Imberti R, Cusato M, Villani P, et al. Steady-state pharmacokinetics and BAL concentration of colistin in critically Ill patients after IV colistin methanesulfonate administration. Chest 2010;138:1333-1339.
- Athanassa ZE, Markantonis SL, Fousteri MZ, et al. Pharmacokinetics of inhaled colistimethate sodium (CMS) in mechanically ventilated critically ill patients. Intensive Care Med. 2012;38:1779-1786.
- Rattanaumpawan P, Lorsutthitham J, Ungprasert P, et al. Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother 2010;65:2645–2649
- Kofteridis DP, Alexopoulou C, Valachis A, et al. Aerosolized plus Intravenous Colistin versus Intravenous Colistin Alone for the Treatment of Ventilator-Associated Pneumonia: A Matched Case-Control Study. Clin Infect Dis 2010;51:1238–1244
- Berlana D, Llop JM, Fort E, et al. Use of colistin in the treatment of multipledrugresistant gram-negative infections. Am J Health Syst Pharm 2005;62:39–47.
- Valachis A, Samonis G, Kofteridis DP. The role of aerosolized colistin in the treatment of ventilator-associated pneumonia: a systematic review and metaanalysis. Crit Care Med. 2015;43:527-533
- Boisson M, Jacobs M, Grégoire N, et al. Comparison of intrapulmonary and systemic pharmacokinetics of colistin methanesulfonate (CMS) and colistinafter aerosol delivery and intravenous administration of CMS in critically ill patients. Antimicrob Agents Chemother. 2014;58:7331-7339
- Tumbarello M, De Pascale G, Trecarichi EM, et al. Effect of aerosolized colistin as adjunctive treatment on the outcomes of microbiologically documented ventilator-associated pneumonia caused by colistin-only susceptible gram-negative bacteria. Chest. 2013;144:1768-1775
- Luyt CE, Clavel M, Guntupalli K, et al. Pharmacokinetics and lung delivery of PDDS-aerosolized amikacin (NKTR-061) in intubated and mechanically ventilated patients with nosocomial pneumonia. Critical Care 2009,13:R200
- Czosnowski QA, Wood GC, Magnotti LJ et al. Adjunctive aerosolized antibiotics for treatment of ventilator-associated pneumonia. Pharmacotherapy 2009;29:1054-1060
- Hallal A, Cohn SM, Namias N et al. Aerosolized tobramycin in the treatment of ventilator-associated pneumonia: a pilot study. Surg Infect (Larchmt) 2007;8:73-82.
- Ghannam DE, Rodriguez GH, Raad II et al. Inhaled aminoglycosides in cancer patients with ventilator-associated gram negative bacterial pneumonia: safety and feasibility in the era of escalating drug resistance. Eur J Clin Microbiol Infect Dis 2009; 28:253-259.
- Niederman MS, Chastre J, Corkery K, et al. BAY41-6551 achieves bactericidal tracheal aspirate amikacin concentrations in mechanically ventilated patients with Gram-negative pneumonia. Intensive Care Med 2012;38:263–271
- Palmer LB, Smaldone GC. Reduction of bacterial resistance with inhaled antibiotics in the intensive care unit. Am J Respir Crit Care Med 2014;189:1225-1233
- de Jesús Valle MJ, González López F, DomÃnguez-Gil Hurle A, et al. Pulmonary versus Systemic Delivery of Antibiotics: Comparison of Vancomycin Dispositions in the Isolated Rat Lung. Antimicrob Agents Chemother 2007;51:3771-3774
- Ferrari F, Lu Q, Girardi C et al. Nebulized ceftazidime in experimental pneumonia caused by partially resistant Pseudomonas aeruginosa. Intensive Care Med 2009;35:1792-1800.
- Wood GC, Boucher BA, Croce MA et al. Aerosolized ceftazidime for prevention of ventilator-associated pneumonia and drug effects on the proinflammatory response in critically ill trauma patients. Pharmacotherapy 2002;22:972-982.
- Claridge JA, Edwards NM, Swanson J et al. Aerosolized ceftazidime prophylaxis against ventilator-associated pneumonia in high risk trauma patients: results of a double-blind randomized study. Surg Infect (Larchmt) 2007;8:83-90
- Badia JR, Soy D, Adrover M et al. Disposition of instilled versus nebulized tobramycin and imipenem in ventilated intensive care unit (ICU) patients. J Antimicrob Chemother 2004; 54:508-514.
- Horianopoulou M, Kanellopoulou M, Paraskevopoulos I et al. Use of inhaled ampicillin-sulbactam against multi-resistant Acinetobacter baumannii in bronchial secretions of intensive care unit patients. Clin Microbiol Infect 2004;10:85-86.
- Karageorgopoulos DE, Wang R, Yu XH, et al. Fosfomycin: evaluation of the published evidence on the emergence of antimicrobial resistance in Gramnegative pathogens. J Antimicrob Chemother 2012;67:255–268.
- Trapnell BC, McColley SA, et al. Fosfomycin/tobramycin for inhalation in patients with cystic fibrosis with Pseudomonas airway infection. Am J Respir Crit Care Med 2012;185:171-178.
- Montgomery AB, Vallance S, Abuan T et al. A randomized double-blind placebocontrolled dose-escalation phase I study of aerosolized amikacin and fosfomycin delivered via the PARI investigational eFlow inline nebulizer system in mechanically ventilated patients. J Aerosol Med Pulm Drug Deliv 2004;27:441-448
- Montgomery AB, Rhomberg PR, Abuan T. et al. Amikacin-fosfomycin at a five-to two ratio: characterization of mutation rates in microbial strains causing ventilatorassociated pneumonia and interactions with commonly used antibiotics. Antimicrob Agents Chemother 2014;58:3708-3713