Aerosol Polymyxin and Pneumonia in Seriously Ill Patients

Pneumonia caused by Pseudomoncis aeruginosa occurs frequently in critically ill patients and is associated with a mortality rate of 70 per cent. An aerosol of polymyxin B was administered (2.5 mg per kilogram per day) to the upper airways of 292 patients in a respiratory-surgical intensive-care unit during a seven-month period, in an attempt to prevent Ps. aeruginosa pneumonia. Although only one of the patients studied acquired pneumonia due to Ps. aeruginosa, 10 others acquired pneumonia caused by a polymyxin-resistant organism. Seven pneumonias were caused by organisms not frequently pathogenic to man (flavobacteria, serratia and Streptococcus faecalis). The mortality rate for acquired pneumonia in this study, 64 per cent, is greater than that in previous studies in which either no polymyxin or cyclic polymyxin therapy was used. Continuous use of polymyxin B aerosol appears to be a dangerous form of therapy. (N Engl J Med 293:471–475, 1975), THE development of gram-negative bacillary pneumonia in a critically ill patient is a serious complication associated with a high mortality rate. During the first 2 1/2 years of operation of our respiratory-surgical intensive-care unit the mortality rate for pneumonia caused by Pseudomonas aeruginosa was 70 per cent.