Efficacy of Inhaled Colistin in Critically Ill Children with Ventilator-Associated Pneumonia Resistant to Multiple Drugs

Background: Ventilator-associated pneumonia (VAP) is the leading cause of death related to mechanical ventilation and the most common nosocomial infection in the intensive care unit (ICU).Objectives: This study aimed to investigate the efficacy of adjunctive inhaled colistin in critically ill children with multidrug-resistant ventilator-associated pneumonia (MDR-VAP). Methods: In this prospective cohort study, 80 critically ill patients aged 2 to 18 years with MDR-VAP were admitted to the PICU of Mofid Children s Hospital in Tehran between 2019 and the end of 2022. Eligible patients were divided into two equal groups: The colistin group (receiving inhaled colistin in addition to other antibiotics) and the control group (receiving only intravenous antibiotics). Clinical and laboratory findings were compared between the two groups. Results: The mean ages of participants in the control and colistin groups were 21.2 ± 2.9 and 24.9 ± 1.7 months, respectively (P = 0.51). The duration of hospital stay in the colistin group was 34.92 ± 20.03 days, compared to 29.83 ± 22.35 days in the control group, which was not statistically significant (P = 0.29). The duration of mechanical ventilation use was similar between the control group (23.15 ± 21.17 days) and the colistin group (24.06 ± 17.87 days) (P = 0.83). Mortality rates were also comparable, with 65% in the control group and 57.5% in the colistin group (P = 0.49). Conclusions: Inhaled colistin did not significantly reduce the duration of hospitalization, the duration of mechanical ventilation use, or the mortality rate in critically ill children with MDR-VAP. Further multicenter studies with larger sample sizes are recommended to validate these findings.