iarjmsIARJMSIARJMS2708-3594https://doi.org/10.47310/iarjms.2021.v02i01.031Colistin Nebulizer Clinical Effects on Mechanically Ventilated Critically Ill Patients with Ventilator-Associated PneumoniaTahaniAbdelkareemAlshqirateEmanFaisalNawaflehRamiMahmoudAl-LawamaTahanieAliAl-QhewiiBaselNaemAl-RawashdehObjectives: Globally, the prevalence of multi-drug-resistant gram negative-bacteria is increasing in an exaggerated manner making the importance of conserving salvaging antibiotics such as Colistin is of our urgent priority. Our objectives in this study are to investigate the clinical impacts of Colistin nebulizer when adjunctively used at dose regimen of 1 MIU TID with Colistin IV. Methods: An observational retrospective study was conducted on eligible 122 adult mechanically ventilated critically ill refractory VAP infected patients admitted to adult ICU of King Hussein Medical Hospital (KHMH) at the Royal Medical Services (RMS) in Jordan between April 2017 and January 2019. All eligible mechanically ventilated critically ill VAP affected patients were allocated into either Group I (Colistin IV + Colistin Neb) or Group II (Colistin IV). Results: The mean age of the whole study cohort was 59.90±10.85 years and Group II cohort were insignificantly older than Group I cohort [60.10±11.65 years vs 59.70±10.05 years, respectively, p>0.05]. Males were significantly distributed in our study at ratio approximately 2:1 compared to females [86 (70.5%) vs 36 (29.5%), respectively, p<0.05] in which 66.7% (40 VAP infected ICU admitted males) were grouped to Group I compared with 25.8% (VAP infected ICU admitted females) were grouped to Group II. The primary outcome of this study (An overall 28-day ICU mortality) was detected in fifty-two (N=52) with an overall incidence of 46.62% during an average of 10.89±5.34 days and 12.66±5.91 days of ICU and overall hospital. Conclusion: Colistin nebulizer at dose regimen of 1 MIU TID has a positive clinical impact when is adjunctively used with renal-adjusted Colistin IV in mechanically ventilated critically ill patients with ventilator associated pneumonia which caused by multi-drug-resistant gram-negative bacteria. Also, this dual Colistin delivery may mitigate the emergence of pan-resistant GNB by conserving Colistin activity via maximizing its PK/PD parameters.