
    lack of inclusion
  
['ventilator-associated pneumonia']
['intravenous colimycin', 'intravenous placebo', 'nebulized colimycin', 'nebulized placebo']

        Inclusion criteria

          -  Age older than 18 yr

          -  Invasive mechanical ventilation for more than 48 h Tracheostomized patients receiving
             intermittent mechanical ventilation can be included

          -  VAP caused by Gram-negative MDR bacteria resistant to all β-lactams and
             fluoroquinolones

        Exclusion criteria

          -  Extrapulmonary Gram-negative MDR infection requiring intravenous colimycin

          -  VAP associated with bacteremia requiring combined treatment by nebulized and
             intravenous colimycin

          -  Hypersensitivity to colistimethate, colistin base, polymyxins and/or their excipients

          -  Porphyria

          -  Severe hypoxemia defined as PaO2 / FiO2< 100; if veno-venous ECMO is initiated, the
             patient can be included

          -  Severe brain injury (initial Glasgow coma score < 8) during the first 7 days before
             randomization

          -  Myasthenia

          -  cystic fibrosis

          -  Refusal to participate in the study

          -  Participation in any clinical study of a therapeutic investigational product within 30
             days prior to the first day of inclusion

          -  No affiliation to social health insurance

          -  Patient under guardianship

          -  Pregnancy
      