Management of ventilator-associated pneumonia: A comparison of two therapeutic approaches due to multidrug-resistance Acinetobacter; a controlled clinical trial study

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is a complicated condition that usually occurs two-three days after endo-tracheal intubation and is characterized by some signs and symptoms such as fever, changed white blood cell count and chest infiltration. Objectives: Our study was aimed at comparing the therapeutic effects of meropenem, injectable colistin plus nebulized colistin and meropenem, injectable colistin, plus nebulized G-CSF (granulocyte-colony stimulating factor) in patients with VAP as a result of multidrug-resistance Acinetobacter. Patients and Methods: VAP patients were randomly divided into two groups (n= 30/each; control group are patients who received IV (intravenous) meropenem, injectable colistin plus nebulized colistin, as a routine treatment, while the intervention group consisted of patients who received IV meropenem, injectable colistin, plus nebulized G-CSF. A total of 14 days of therapeutic intervention are required for every case. Follow-up for subjects was performed at 5 time-points; days 1, 3, 5, 7, and 14 after intervention. In the present study, the clinical pulmonary infection score (CPIS) was determined on the basis of points assigned for various clinically manifestations of VAP. Results: The mean of ages in the two groups of routine treatment and intervention were 60.1 ± 13.7 years and 59.7 ± 18.4 years, respectively. There is no significant difference between ages in two groups of subjects (P = 0.93). Based on our statistically analysis, no significant difference between CPIS in both groups 1 and 2 was detected (P > 0.05). Conclusion: CPIS and some other clinical investigations appeared effectiveness of the treatment with injected colistin, nebulized colistin plus nebulized G-CSF for management of VAP. Based on the results of our study, aforementioned therapeutic approach can be used as an alternative treatment for the management of infection in VAP cases; however, in order to make a definite statement about the effectiveness of our proposed treatment, further studies with a cellular and molecular approach are necessary. Trial Registration: This study was registered at the Iranian website for registration of clinical trials (#IRCT20150824023743N2, https://irct.ir/trial/41023, with regional ethical code of IR.MUI.MED.REC.1397.052).