Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Trial of Aerosolized Colistin for the Treatment of Nosocomial Pneumonia due to Multidrug-resistant Acinetobacter baumannii

다제내성 A. baumannii에 의한 병원획득폐렴에서 Colistin 분무치료의 시도

  • Kim, Changhwan (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Kim, Dong-Gyu (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Kang, Hye-Ryun (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Choi, Jeong-Hee (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Chang Youl (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Hwang, Yong Il (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Shin, Tae Rim (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Park, Sang Myeon (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Park, Yong Bum (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Jae Young (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Jang, Seung Hun (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Kim, Cheol Hong (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Mo, Eun Kyung (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Myung Goo (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Hyun, In-Gyu (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Jung, Ki-Suck (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Choi, Young-Jin (Department of Internal Medicine, Hallym University College of Medicine) ;
  • Lee, Jae Woong (Department of Thoracic & Cardiovascular Surgery, Hallym University College of Medicine)
  • 김창환 (한림대학교 의과대학 내과학교실) ;
  • 김동규 (한림대학교 의과대학 내과학교실) ;
  • 강혜련 (한림대학교 의과대학 내과학교실) ;
  • 최정희 (한림대학교 의과대학 내과학교실) ;
  • 이창률 (한림대학교 의과대학 내과학교실) ;
  • 황용일 (한림대학교 의과대학 내과학교실) ;
  • 신태림 (한림대학교 의과대학 내과학교실) ;
  • 박상면 (한림대학교 의과대학 내과학교실) ;
  • 박용범 (한림대학교 의과대학 내과학교실) ;
  • 이재영 (한림대학교 의과대학 내과학교실) ;
  • 장승훈 (한림대학교 의과대학 내과학교실) ;
  • 김철홍 (한림대학교 의과대학 내과학교실) ;
  • 모은경 (한림대학교 의과대학 내과학교실) ;
  • 이명구 (한림대학교 의과대학 내과학교실) ;
  • 현인규 (한림대학교 의과대학 내과학교실) ;
  • 정기석 (한림대학교 의과대학 내과학교실) ;
  • 최영진 (한림대학교 의과대학 내과학교실) ;
  • 이재웅 (한림대학교 의과대학 흉부외과학교실)
  • Received : 2008.01.05
  • Accepted : 2008.01.29
  • Published : 2008.02.28
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Abstract

Background: Recently, multidrug-resistant (MDR) A. baumannii has been implicated for a significant proportion of nosocominal pneumonia in many intensive care units (ICUs), and its acquisition may increase mortality and the length of stay in the ICU. Aerosolized colistin has been successfully used in patients with cystic fibrosis, but there is a lack of data regarding the use of aerosolized colistin in patients with nosocomial pneumonia. Methods: We conducted the present study to assess the effectiveness of aerosolized colistin for the treatment of MDR A. baumannii nosocomial pneumonia. We retrospectively reviewed the medical records of 10 patients who had been hospitalized in the medical ICU and had received aerosolized colistin as a therapy for MDR A. baumannii pneumonia. Results: The mean duration of aerosolized colistin therapy was $12.7{\pm}2.4$ days. Nine (90%) of 10 patients showed a favorable response to the therapy. Follow-up cultures were available for all patients, and the responsible pathogen was completely eradicated. One patient suffered from bronchospasm, which resolved after treatment with nebulized salbutamol. Conclusion: Our results corroborate previous reports that aerosolized colistin may be an effective and safe choice for the treatment of nosocomial pneumonia caused by MDR A. baumannii. Larger prospective controlled clinical studies are warranted to validate further the effectiveness and safety of aerosolized colistin therapy.

연구배경: 최근 다제내성 A. baumannii에 의한 폐렴이 중환자실 환자에서 매우 빈번하게 발생하고 있으며, 이탈 지연, 중환자실 재원기간 및 사망률의 증가가 초래되기도 한다. 수 년 전부터 colistin이 치료제로 다시 주목받고 있으나 병원획득폐렴에 대한 치료 경험은 많지 않으며, 분무치료의 효과에 대해서는 근거가 매우 부족하다. 이에 저자들은 한 대학병원 중환자실에서 발생한 다제내성 A. baumannii에 의한 병원획득폐렴에서 colistin 분무치료의 적용 가능성을 평가해보고자 하였다. 방법: 다제내성 A. baumannii에 의한 병원획득폐렴의 발생이 확인되어 colistin 분무치료를 시행한 환자 10명을 대상으로 후향적 분석을 시행하였다. 결과: Colistin 분무치료 기간은 평균 $12.7{\pm}2.4$일이었다. 10명의 대상환자 중 9명(90.0%)의 환자에서 효과적인 치료 반응을 나타내었다. 치료 종료 후 추적한 객담 배양 검사에서 다제내성 A. baumannii는 단 한 명도 분리되지 않았다. 1명의 환자에서 기관지연축이 발생하였으나 기관지확장제 치료 후 호전되었다. 결론: 다제내성 A. baumannii에 의한 병원획득폐렴에서 colistin 분무치료는 매우 효과적일 가능성이 있으며, 향후 전향적인 연구를 진행할 가치가 있을 것으로 판단된다.

Keywords

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