DISCUSSION
XDR, nosocomial pneumonia
NOSOCOMIAL PNEUMONIA

This was the first open‐label randomized controlled trial focusing on the efficacy of inhaled colistin and fosfomycin/tobramycin in treating XDR Zampieri et al. examined 12 clinical trials on the effectiveness of inhaled antibiotics in treating Stentobacter and In clinical trials conducted by Doshi,In two clinical trial studies conducted by HallalWood et al. in 2017 assessed clinical investigations on the impact of inhaled antibiotics on nosocomial pneumonia treatment between 2010 and 2017. Colistin and aminoglycosides, including tobramycin, were the most common antibiotics, and In 2012, Arnold et al. studied the effect of inhaled supplementary colistin and tobramycin in treating 93 subjects with Hallal et al. showed that the outcome of patients with These studies, consistent with our research, show the favorable effect of these two inhaled drugs for adjuvant therapy in treating XDR At the same time, our study faced limitations such as small sample size, and therefore, in order to obtain a general and credible conclusion, further studies in this field are necessary. With considering the different interval doses of inhaled agents (the control group was given inhaled colistin 1 million IU every 8 h, whereas the case group was given inhaled tobramycin/fosfomycin 300 mg every 12 h/80 mg every 12 h), the primary outcome (treatment duration) was determined by the investigator who could not blinded to treatment allocation. Therefore, despite the ideality of blinding the study, it was not possible, and the study was conducted in an open‐label format. Also, minimal inhibitory concentrations were not established and is another limitation of the study.