{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T02:53:02Z","timestamp":1790650382698,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T00:00:00Z","timestamp":1673222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry for University and Scientific Research","award":["GR-2018\u201312367375"],"award-info":[{"award-number":["GR-2018\u201312367375"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>(1) Background: Colistin-only susceptible (COS) Acinetobacter baumannii (AB) ventilator-associated pneumonia (VAP) represents a clinical challenge in the Intensive Care Unit (ICU) due to the negligible lung diffusion of this molecule and the low-grade evidence on efficacy of its nebulization. (2) Methods: We conducted a prospective observational study on 134 ICU patients with COS-AB VAP to describe the \u2018real life\u2019 clinical use of high-dose (5 MIU q8) aerosolized colistin, using a vibrating mesh nebulizer. Lung pharmacokinetics and microbiome features were investigated. (3) Results: Patients were enrolled during the COVID-19 pandemic with the ICU presenting a SAPS II of 42 [32\u201357]. At VAP diagnosis, the median PaO2\/FiO2 was 120 [100\u2013164], 40.3% were in septic shock, and 24.6% had secondary bacteremia. The twenty-eight day mortality was 50.7% with 60.4% and 40.3% rates of clinical cure and microbiological eradication, respectively. We did not observe any drug-related adverse events. Epithelial lining fluid colistin concentrations were far above the CRAB minimal-inhibitory concentration and the duration of nebulized therapy was an independent predictor of microbiological eradication (12 [9.75\u201314] vs. 7 [4\u201313] days, OR (95% CI): 1.069 (1.003\u20131.138), p = 0.039). (4) Conclusions: High-dose and prolonged colistin nebulization, using a vibrating mesh, was a safe adjunctive therapeutic strategy for COS-AB VAP. Its right place and efficacy in this setting warrant investigation in interventional studies.<\/jats:p>","DOI":"10.3390\/antibiotics12010125","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T04:42:17Z","timestamp":1673239337000},"page":"125","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Use of High-Dose Nebulized Colistimethate in Patients with Colistin-Only Susceptible Acinetobacter baumannii VAP: Clinical, Pharmacokinetic and Microbiome Features"],"prefix":"10.3390","volume":"12","author":[{"given":"Gennaro","family":"De Pascale","sequence":"first","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"},{"name":"Dipartimento di Scienze Biotecnologiche di base Cliniche Intensivologiche e Perioperatorie,\r\nUniversita\u2019 Cattolica del Sacro Cuore, Rome, L.go F. Vito 1, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Pintaudi","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Lisi","sequence":"additional","affiliation":[{"name":"Section of Pharmcology, Department of Healthcare Surveillance and Bioethics,\r\nCatholic University Medical School, Fondazione Policlinico Universitario A. Gemelli IRCCS,\r\nL.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"De Maio","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore Lucio","family":"Cutuli","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eloisa Sofia","family":"Tanzarella","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Carelli","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmarco","family":"Lombardi","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0944-0101","authenticated-orcid":false,"given":"Melania","family":"Cesarano","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Gennenzi","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriella Maria Pia","family":"Ciotti","sequence":"additional","affiliation":[{"name":"Section of Pharmcology, Department of Healthcare Surveillance and Bioethics,\r\nCatholic University Medical School, Fondazione Policlinico Universitario A. Gemelli IRCCS,\r\nL.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico Luca","family":"Grieco","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brunella","family":"Posteraro","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biotecnologiche di base Cliniche Intensivologiche e Perioperatorie,\r\nUniversita\u2019 Cattolica del Sacro Cuore, Rome, L.go F. Vito 1, 00168 Rome, Italy"},{"name":"Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS,\r\nL.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Sanguinetti","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"},{"name":"Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Navarra","sequence":"additional","affiliation":[{"name":"Section of Pharmcology, Department of Healthcare Surveillance and Bioethics,\r\nCatholic University Medical School, Fondazione Policlinico Universitario A. Gemelli IRCCS,\r\nL.go A. Gemelli 8, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Dell\u2019emergenza, Anestesiologiche e Della Rianimazione,\r\nFondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy"},{"name":"Dipartimento di Scienze Biotecnologiche di base Cliniche Intensivologiche e Perioperatorie,\r\nUniversita\u2019 Cattolica del Sacro Cuore, Rome, L.go F. Vito 1, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1378\/chest.13-1018","article-title":"Effect of aerosolized colistin as adjunctive treatment on the outcomes of microbiologically documented ventilator-associated pneumonia caused by colistin-only susceptible gram-negative bacteria","volume":"144","author":"Tumbarello","year":"2013","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/2110-5820-1-30","article-title":"Colistin: Recent data on pharmacodynamics properties and clinical efficacy in critically ill patients","volume":"1","author":"Michalopoulos","year":"2011","journal-title":"Ann. 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Infect."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/1\/125\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:04:09Z","timestamp":1760119449000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/1\/125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,9]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["antibiotics12010125"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12010125","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,9]]}}}