What Is the Efficacy and Safety of Colistin for the Treatment of Ventilator-Associated Pneumonia? A Systematic Review and Meta-Regression

(See the Editorial Commentary by Falagas and Rafailidis, on pages 681–3.) Background. Experience with intravenous and aerosolized forms of colistin for the treatment of ventilator-associated pneumonia (VAP) in patients without cystic fibrosis is limited. We aimed to assess the safety and efficacy of colistin for the treatment of VAP. Methods. We searched MEDLINE and Cochrane Database of Systematic Reviews for studies comparing colistin vs other antibiotics for treatment of VAP in patients without cystic fibrosis. QUOROM guidelines were followed, the I2 method was used for heterogeneity, and a random-effects model for odds ratio (OR) estimates. Results. Six controlled studies met the inclusion criteria. Clinical response did not differ significantly between colistin and control groups (OR, 1.14; 95% confidence interval [CI], .74–1.77; P = .56; I2 = 0%). The efficacy of colistin was independent of study design (prospective OR, 0.89 [95% CI, .48–1.66; P = .71; I2 = 0%]; retrospective OR, 1.45 [95% CI, .79–2.68; P = .23; I2 = 0%]); randomized trials OR, 0.86 [95% CI, .43–1.74; P = .68; I2 = 0%]). There was no indication of a significant change in clinical response after controlling for concomitant antibiotic treatment (intercept, 0.121; slope, 0.0315; P = .95). Treatment with colistin vs controls did not affect hospital mortality (OR, 0.92; 95% CI, .50–1.67; P = .78; I2 = 34.59%) or nephrotoxicity (OR, 1.14; 95% CI, .59–2.20; P = .69; I2 = 0%). Fourteen single-arm studies have been analyzed, and the results were in concordance with the findings of the controlled studies. Conclusions. Our results suggest that colistin may be as safe and as efficacious as standard antibiotics for the treatment of VAP.