Title

Prevention of descending pneumonia in rts with perflubron-delivered tobramycin

UMMS Affiliation

Department of Anesthesiology; Department of Surgery; Department of Emergency Medicine

Publication Date

2003-10

Document Type

Article

Subjects

Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Disease Models, Animal; Intubation; Klebsiella Infections; Klebsiella pneumoniae; Pneumonia, Bacterial; Prospective Studies; Rats; Rats, Wistar; Tobramycin; Ventilators, Mechanical

Disciplines

Anesthesiology | Emergency Medicine

Abstract

OBJECTIVES: Patients undergoing emergent endotracheal intubation are at increased risk for developing pneumonia. Although numerous strategies have been investigated to reduce ventilator-associated pneumonia (VAP), the incidence of VAP and its associated mortality remains high. This investigation tested the hypothesis that LiquiVent (Alliance Pharmaceutical, San Diego, CA-LV) delivered antibiotics (via spray-dried microspheres-SDM) would improve survival in a rat model of descending gram-negative pneumonia.

METHODS: Wistar rats (n = 49) were randomized to receive prophylaxis with 1). nothing (controls); 2). intramuscular (IM) tobramycin, 3). intratracheal LV plus SDM shells (vehicle), 4). intratracheal LV plus SDM shells plus IM tobramycin, or 5). intratracheal LV plus SDM containing 1 mg/kg of tobramycin. All interventions were given 24 hours before a bacterial challenge with 10(8) colony-forming units of intratracheal Klebsiella pneumoniae. Mortality at ten days was the sole outcome measure. Survival in individual groups was compared with controls by Fisher's exact test with Bonferroni correction for multiple comparisons.

RESULTS: All animals in the control group died of pneumonia within ten days of bacterial inoculation (0% survival). Prophylaxis with either IM tobramycin or SDM vehicle plus IM tobramycin provided no protection (0% survival). This is in sharp contrast to the cohort receiving pretreatment with tobramycin-containing SDM delivered via LV, in which 60% of the animals survived to study completion (p < 0.05).

CONCLUSIONS: Prophylaxis with SDM containing antibiotics delivered in low-dose LV provided significant protection in a rat model of descending gram-negative pneumonia. These data support the hypothesis that perfluorocarbon-delivered intratracheal antimicrobials may be useful in the prevention of VAP.

DOI of Published Version

10.1197/S1069-6563(03)00335-X

Source

Acad Emerg Med. 2003 Oct;10(10):1019-23. DOI: 10.1197/S1069-6563(03)00335-X

Journal/Book/Conference Title

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

Related Resources

Link to Article in PubMed

PubMed ID

14525730

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