Effectiveness of treatment with nebulized colistin in patients with COPD

Nuria Bruguera-Avila,^1–3 Alicia Marin,^3–5 Ignasi Garcia-Olive,^3–5 Joaquim Radua,^6–8 Cristina Prat,^4,9,10 Montserrat Gil,³ Juan Ruiz-Manzano<sup>2–5

1</sup>Department of Medicine, Hospital Sant Jaume de Calella, Calella, Barcelona, Spain; ²Department of Medicine, Universitat Autònoma de Barcelona, Bellatera, Spain; ³Department of Pulmonary Medicine, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain; ⁴Ciber de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; ⁵Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain; ⁶Department of Statistics, FIDMAG Germanes Hospitalaries Research Unit, Sant Boi de Llobregat, Barcelona, Spain; ⁷CiberSam – Ciber de Salud Mental, Madrid, Spain; ⁸Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; ⁹Department of Microbiology, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet sn, Badalona, Barcelona, Spain; ¹⁰Department of Genetics and Microbiology of Universitat Autònoma de Barcelona, Bellatera, Spain

Objectives: To analyze whether the introduction of nebulized colistin in patients with chronic obstructive pulmonary disease (COPD) and infection with Pseudomonas aeruginosa (PA) is associated with a decrease of the number and duration of severe exacerbations.
Materials and methods: Thirty six patients with COPD and infection with PA treated with nebulized colistin attending a day hospital during a 5-year (January 2010–December 2014) period were prospectively included. Repeated-measures t-tests were used to assess whether the introduction of colistin was associated with changes in the number of exacerbations or the length of the hospitalizations, comparing for each patient the year prior to the introduction of colistin with the year after.
Results: After the introduction of colistin, the number of admissions decreased from 2.0 to 0.9 per individual year (P=0.0007), and hospitalizations were shorter (23.3 vs 10.9 days, P=0.00005). These results persisted when patients with and without bronchiectasis or with and without persistence of Pseudomonas were separately analyzed. No pre–post differences were detected in the number of exacerbations not requiring admission.
Conclusion: Nebulized colistin seems associated with a strong decrease in the number and duration of hospitalizations due to exacerbation in patients with COPD and infection with PA. Clinical trials with a larger number of patients are needed in order to confirm these results.

Keywords: bronchiectasis, colistin, COPD, nebulized antibiotics