2026-10-14T06:49:30Z https://api.figshare.com/v2/oai

oai:figshare.com:article/33919492 2026-09-18T04:27:47Z category_19 portal_316 item_type_3 month_year_09_2026

Supplementary file 1_Timing of nebulized colistimethate sodium following bronchodilator airway conditioning in hospital-acquired pneumonia: a target trial emulation study.docx Yi Cui (128888) Qiannan Zhao (5446778) Jianning Zhang (570988) Siyu Lu (1412086) Shuai Li (65944) Lufeng Zhao (7403018) Ming Gao (115719) Hao Chen (5190) Hui Han (292946) Xiaofang Huang (1917505) Pharmacology colistin hospital-acquired pneumonia (HAP) microbiological clearance multi-drug-resistant Gram-negative bacteria (MDR-GNB) target trial emulation Background<p>Evidence for nebulized colistimethate sodium (CMS) in hospital-acquired pneumonia (HAP) remains inconsistent, potentially due to heterogeneity in airway conditions and delivery timing. We evaluated whether timely initiation of nebulized CMS following bronchodilator airway pre-treatment was associated with microbiological outcomes in critically ill patients.</p>Methods<p>We conducted a multicenter retrospective cohort study using target trial emulation among adult ICU patients with HAP who received nebulized CMS following bronchodilator nebulization. Two per-protocol strategies were compared: initiation within 90 min of bronchodilator nebulization (LE90) versus later initiation (GT90). Cloning, censoring, and inverse probability of censoring weighting were applied to address time-dependent confounding. The primary outcome was 14-day cumulative incidence of microbiological clearance, treating death as a competing event.</p>Results<p>Among 218 eligible patients, timely initiation was associated with a higher weighted cumulative incidence of microbiological clearance at day 14 (71.9% vs. 52.6%; absolute difference 19.3%, 95% CI 4.8–32.5; P = 0.012) and a shorter restricted mean time alive and not microbiologically cleared (6.85 vs. 10.08 days; difference −3.23 days, 95% CI −4.30 to −2.08; P < 0.001). Findings were consistent across subgroups and robust in sensitivity analyses. No significant differences were observed in clinical success, superinfection, mortality, ICU length of stay, or ventilator-free days. Bronchospasm incidence was similar between strategies.</p>Conclusion<p>Timely initiation of nebulized CMS within a defined post-bronchodilator window was associated with higher microbiological clearance and reduced persistent infection, without increased airway adverse events. These findings are hypothesis-generating and require prospective validation, particularly with respect to patient-centered outcomes.</p> 2026-09-18T04:27:47Z Dataset Dataset 10.3389/fphar.2026.1859337.s001 https://figshare.com/articles/dataset/Supplementary_file_1_Timing_of_nebulized_colistimethate_sodium_following_bronchodilator_airway_conditioning_in_hospital-acquired_pneumonia_a_target_trial_emulation_study_docx/33919492 CC BY 4.0