Nebulized Amikacin In Ventilator-Associated Tracheobronchitis Caused By Pseudomonas Aeruginosa

ObjectiveRICU patients receiving mechanical ventilation who have diagnosis ofventilator-associated tracheobronchitis(VAT) caused by Pseudomonas aerugi-nosa,received treatment of nebulized amikacin and intravenous amikacin.Toassess the clinical value of nebulized amikacin in ventilator-associatedtracheobronchitis caused by Pseudomonas aeruginosat.MethodsSelected patients receiving mechanical ventilation stay at RICU as theprimary object,the patients ventilator-associated tracheobronchitis caused byPseudomonas aeruginosa were randommized divided into two groups,mean thetreatment group and control group.On the basis of intravenous other anti-biotics,bronchoalveolar Lavage,nutritional support,the regulation of water andelectrolyte balance,received nebulized amikacin and intravenous amikacin for8days.After treatment,other treatment decided by basic diseases.Duringtreatment and after treatment,compared the different in terms of improvement ofclinical symptoms,CPIS,white blood cell count,bacterial clearance rate andantibiotic resistance.Continue to follow-up20days,compared the differentmentin terms of duration of MV, length of stay in ICU and mortality.Results1.Bacterial clearance rate and antibiotic resistance of Pseudomonasaeruginosa:(1) Bacterial clearance rate:Bacterial clearance rate was83.33%inthe nebulized group,45.00%in the intravenous group in the3days (P<0.05).Bacterial clearance rate was100.00%in the nebulized group,60.00%in the intravenous group in the5days(P<0.05).Bacterial clearance rate was100.00%in the nebulized group,75.00%in the intravenous group in the7days(P<0.05). Bacterial clearance rate was100.00%in the nebulized group,80.00%in the intravenous group in9days (P>0.05).(2) Antibiotic resistance: At the endof the treatment,the Pseudomonas aeruginosa were not antibiotic resis-tance.The intravenous group have4Pseudomonas aeruginosat resistance foramikacin.2.Comparison of clinical efficacy:CPIS was reduced gradually with treat-ment.The improvement of CPIS was more significant in nebulized group(P<0.05).The white blood cell count was reduced gradually in two groups,butwere not different between groups(P>0.05).Aerosol and intravenous amikacingroups were similar in terms of clinical efficacy:The cure rate in nebulized groupwas83.33%,was70.00%in intravenous group (P>0.05).3.After the end of the follow-up,aerosol and intravenous amikacin groupswere similar in terms of duration of mechanical ventilation(MV),length of stay inICU and mortality.Conclusions1.Nebulization is more efficient in terms of reducing the number of bacteriaculcure compared to intravenous amikacin in VAT cause by Pseudomonas aeru-ginosa,and prevent the per-treatment emergence of resistant strains.2.Nebulization and intravenous amikacin provide similar clinical efficacy.3.In period of28days,nebulized and intravenous amikacin groups weresimilar in terms of duration of MV, length of stay in ICU and mortality.4.Nebulized amikacin is effective treatment for Ventilator-AssociatedTracheobronchitis Caused by Pseudomonas aeruginosat.