{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T06:58:05Z","timestamp":1790578685839,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T00:00:00Z","timestamp":1790467200000},"content-version":"vor","delay-in-days":269,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Critical Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Multidrug\u2010resistant\n                      <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                      (MDR PA) ventilator\u2010associated pneumonia (VAP) and hospital\u2010associated pneumonia (HAP) are associated with high morbidity and limited therapeutic options. Intravenous antibiotics often achieve inadequate pulmonary concentrations. Aerosolized delivery permits high local drug exposure, but data on combined inhaled polymyxin\u2013aminoglycoside therapy remain limited.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>We describe three critically ill patients with HAP\/VAP due to MDR PA. All received adjunctive high\u2010dose inhaled colistin immediately followed by inhaled amikacin or tobramycin, in addition to systemic therapy. Dosing was individualized based on renal function. Nebulization was optimized using inspiratory\u2010synchronized delivery. All patients demonstrated clinical improvement, reductions in inflammatory markers (though with a transient rise in one or more markers in two patients), radiologic resolution, and eventual microbiologic eradication, despite isolates reported as resistant to the aminoglycoside and colistin used in vitro. No nephrotoxicity, bronchospasm, or device\u2010related complications were observed clinically, despite doses exceeding those commonly reported, although formal ototoxicity surveillance was not performed. However, because all patients also received concurrent systemic antibiotics, a specific causal contribution from inhaled therapy cannot be fully established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dual inhaled colistin\u2013aminoglycoside therapy may represent a pharmacokinetically rational adjunctive strategy in selected patients with MDR PA HAP\/VAP. High intrapulmonary concentrations achieved through aerosolization may overcome resistance while maintaining acceptable systemic safety. Prospective PK\u2010guided studies are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crcc\/9472232","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T06:49:19Z","timestamp":1790578159000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["High\u2010Dose Inhaled Colistin\u2013Aminoglycoside Combination Therapy in Critically Ill Patients With Multidrug\u2010Resistant\n                    <i>Pseudomonas aeruginosa<\/i>\n                    Hospital\/Ventilator\u2010Associated Pneumonia: A Case Report and Literature Review"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-8271-766X","authenticated-orcid":false,"given":"Thang 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