Comparative effectiveness of intravenous versus inhalational antibiotic administration for the management of Acinetobacter pneumonia: A randomized controlled trial.

BACKGROUND: Aerosol antibiotics directly target the respiratory tract, bypassing the poor lung penetration of many intravenous antibiotics. However, they seem like they could be useful for treating ventilator-associated pneumonia (VAP); not enough research has been done on how well inhaled and intravenous treatments work. The existing literature does not give definitive information regarding which method yields superior therapeutic outcomes. OBJECTIVE: To evaluate the therapeutic effects of intravenous versus inhaled colistin in treating Acinetobacter VAP in severe traumatic brain injury patients. METHODOLOGY: This prospective, multicenter, randomized, double-blind study compared inhaled versus intravenous colistin for Acinetobacter VAP using clinical and laboratory markers of infection and organ function. It was conducted from February 1, 2023, to March 1, 2024, at four Ukrainian medical institutions in Kyiv, Ternopil, and Khmelnytsky. RESULTS: Both routes significantly reduced leukocyte counts (p < 0.001) and clinical pulmonary infection score (CPIS) (p < 0.001). Inhaled colistin improved PaO2/FiO2 ratios from 337 to 343 mmHg (p = 0.010), while intravenous colistin did not show a significant change (p = 0.334). Intravenous administration better preserved systemic organ function, with sequential organ failure assessment (SOFA) scores worsening from 12 to 13 (p < 0.001), compared to inhalation, which worsened from 12 to 14 (p < 0.001). Neither route significantly affected sepsis incidence (inhalation 33% vs. intravenous 22.5%, p = 0.116) or 28-day mortality (inhalation 27% vs. intravenous 20.6%, p = 0.362). Male gender was an independent predictor of mortality (OR 0.44, 95% CI 0.20-0.99, p = 0.046). CONCLUSION: Post-treatment physiological status was the primary determinant of outcomes in Acinetobacter baumannii VAP patients with severe traumatic brain injury.