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已发表论文
不同黏菌素给药途径治疗碳青霉烯耐药菌所致医院获得性肺炎的疗效和安全性：一项单中心、开放标签、前瞻性队列研究
Authors Wei QY, Shen W, Chen ZY, Chen XX, Xu F, Fan H
Received 31 October 2025
Accepted for publication 17 January 2026
Published 30 January 2026 Volume 2026:20 577270
DOI https://doi.org/10.2147/DDDT.S577270
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Muzammal Hussain
Qiao-Yi Wei,1 Wei Shen,1 Zhao-Yuan Chen,1 Xin-Xing Chen,1 Feng Xu,1,2,* Heng Fan1,3,*
1Department of Intensive Care Unit, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China; 2Central Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China; 3Department of Critical Care Medicine, People’s Hospital of Ganluo County, Ganluo, Sichuan Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Heng Fan; Feng Xu, Department of Intensive Care Unit, The First Affiliated Hospital of Ningbo University, No. 59 Liuting Road, Ningbo, 315000, People’s Republic of China, Email fyyfanheng@nbu.edu.cn; xufengnbu@163.com
Background: The role of inhaled colistin as either an adjunctive or substitution for nosocomial pneumonia (NP) caused by carbapenem-resistant organisms (CRO) is highly debated due to conflicting clinical evidence. Given the limitations of intravenous therapy, the optimal administration strategy remains a critical, unresolved question. This study aimed to compare the efficacy and safety of three colistin-based regimens administered via different routes.
Methods: In this prospective cohort study, 127 intensive care unit (ICU) patients diagnosed with CRO-related NP and treated with colistin were enrolled. Patients were classified into three groups according to the route of administration: inhalation (IH group), intravenous colistin with adjunctive inhalation (IV+IH group), and intravenous (IV group) therapy. The primary endpoint was clinical efficacy at the end of treatment. Key secondary outcomes included microbiological eradication and nephrotoxicity.
Results: Clinical efficacy was achieved in 72.1% of the IH group, 67.4% of the IV+IH group, and 65% of the IV group, with no statistically significant difference among groups (P=0.786). The IH group demonstrated a significantly higher microbiological eradication rate compared with the IV group (P=0.004). No significant differences were observed in 28-day all-cause mortality, hospital stay duration, or incidence of acute kidney injury (AKI). Moreover, the development of AKI during treatment was strongly associated with clinical failure, suggesting it may serve as a prognostic marker for poor outcomes.
Conclusion: In critically ill patients with CRO-associated NP, inhaled colistin monotherapy provided comparable clinical efficacy to systemic administration. It achieved superior microbiological eradication and showed a favorable safety profile regarding nephrotoxicity, suggesting it represents a viable and potentially safer therapeutic strategy.
Keywords: carbapenem-resistant Gram-negative bacteria, colistin, inhalation therapy, intravenous administration, nosocomial pneumonia
1Department of Intensive Care Unit, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China; 2Central Laboratory, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang Province, People’s Republic of China; 3Department of Critical Care Medicine, People’s Hospital of Ganluo County, Ganluo, Sichuan Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Heng Fan; Feng Xu, Department of Intensive Care Unit, The First Affiliated Hospital of Ningbo University, No. 59 Liuting Road, Ningbo, 315000, People’s Republic of China, Email fyyfanheng@nbu.edu.cn; xufengnbu@163.com
Background: The role of inhaled colistin as either an adjunctive or substitution for nosocomial pneumonia (NP) caused by carbapenem-resistant organisms (CRO) is highly debated due to conflicting clinical evidence. Given the limitations of intravenous therapy, the optimal administration strategy remains a critical, unresolved question. This study aimed to compare the efficacy and safety of three colistin-based regimens administered via different routes.
Methods: In this prospective cohort study, 127 intensive care unit (ICU) patients diagnosed with CRO-related NP and treated with colistin were enrolled. Patients were classified into three groups according to the route of administration: inhalation (IH group), intravenous colistin with adjunctive inhalation (IV+IH group), and intravenous (IV group) therapy. The primary endpoint was clinical efficacy at the end of treatment. Key secondary outcomes included microbiological eradication and nephrotoxicity.
Results: Clinical efficacy was achieved in 72.1% of the IH group, 67.4% of the IV+IH group, and 65% of the IV group, with no statistically significant difference among groups (P=0.786). The IH group demonstrated a significantly higher microbiological eradication rate compared with the IV group (P=0.004). No significant differences were observed in 28-day all-cause mortality, hospital stay duration, or incidence of acute kidney injury (AKI). Moreover, the development of AKI during treatment was strongly associated with clinical failure, suggesting it may serve as a prognostic marker for poor outcomes.
Conclusion: In critically ill patients with CRO-associated NP, inhaled colistin monotherapy provided comparable clinical efficacy to systemic administration. It achieved superior microbiological eradication and showed a favorable safety profile regarding nephrotoxicity, suggesting it represents a viable and potentially safer therapeutic strategy.
Keywords: carbapenem-resistant Gram-negative bacteria, colistin, inhalation therapy, intravenous administration, nosocomial pneumonia