Colistin Is Effective in Treatment of Infections Caused by Multidrug-Resistant Pseudomonas aeruginosa in Cancer Patients

Abstract

The increasing incidence of infections caused by multidrug-resistant Pseudomonas aeruginosa is a worldwide health problem. Because no new antipseudomonal agents are expected to be available in the near future, we evaluated the safety and efficacy of colistin, an old drug with bactericidal activity against this organism. We collected clinical and demographic data on 95 cancer patients diagnosed with infections caused by multidrugresistant P. aeruginosa between January 2001 and January 2004 and treated with either colistin (colistin group) or at least one active antipseudomonal agent (a beta-lactam antibiotic or a quinolone) (control group). We compared the results obtained for both groups. Thirty-one patients had been treated with colistin and 64 had been treated with an antipseudomonal non-colistin-containing regimen. Compared with the control group, patients in the colistin group had a lower median age (52 and 62 years, respectively; P ‫؍‬ 0.012) but were more likely to have had nosocomial infections (87% and 64%, respectively; P ‫؍‬ 0.02). Twenty-five patients (81%) in the colistin group and 40 patients (63%) in the control group had an APACHE II score of >15 (P ‫؍‬ 0.074). The overall clinical response rates were 52% in the colistin group and 31% in the control group (P ‫؍‬ 0.055). Multiple logistic regression analysis showed that those patients treated with colistin were 2.9 times (95% confidence interval, 1.1 to 7.6 times) more likely than those in the control group to experience a clinical response to therapy (P ‫؍‬ 0.026). Colistin therapy was at least as effective and as safe a beta-lactam antibiotic or a quinolone in the treatment of infections caused by multidrug-resistant P. aeruginosa and, hence, may be a useful or preferred alternative therapy for this infection in cancer patients.

Bactericidal Activity in Filtrated Supernatant of Streptococcus Sanguinis against Multidrug-Resistant Pseudomonas Aeruginosa

“…Low-dose macrolide therapy is commonly used to treat patients with chronic pulmonary infection, but there is some concerning the bacteria developing resistance to these drugs. Recently, treatment has become difficult due to nosocomial infections caused by multidrug-resistant P. aeruginosa (MDRP) (Basustaoglu et al 1995;D'Agata 2004;Nouer et al 2005;Rossoline and Mantengoli 2005;Bonomo and Szabo 2006;Paterson 2006;Hachem et al 2007).…”

Efficacy and Safety of Colistin in the Treatment of Infections Caused by Multidrug-resistant Pseudomonas aeruginosa in Patients with Hematologic Malignancy: A Matched Pair Analysis

“…While a randomized trial would be unethical in a patient population such as ours, as it would result in a denial of an only possible life saving antibiotic, alternate clinical scenarios, similar to the one described by Hachem et al (8), should be used to compare efficacy and safety of colistin, both as monotherapy and in combination with other antipseudomonal drugs, to the currently established therapies. Until such studies are designed and conducted, colistin should be used with caution, primarily to avoid selection of resistant strains, as the drug is often the only treatment option when MDR strains emerge.…”

“…Recently, efficacy and safety of colistin were evaluated in patients primarily treated for severe ventilator-associated pneumonia in the setting of intensive care units (4-7), while only one report addressed the population of neutropenic patients: Hachem et al evaluated the efficacy of colistin in cancer patients, mostly patients with hematological malignancy, and found it to be as effective and safe as beta-lactams or fluoroquinolones in the treatment of infections caused by MDR Pseudomonas aeruginosa (MDR-PA) (8).…”

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

“…3 Two retrospective analyses that included patients with (mainly hematological) malignancies who were treated with colistin for MDR P. aeruginosa infections obtained differing results. 5,61 In one study, 31-colistin-treated patients (45% with bacteremia, 55% with pneumonia) were compared to those (n= 64) treated with a non-colistin (β-lactam or quinolone) regimen. The colistin regimen achieved a higher rate of clinical response in multiple logistic regression analysis (P=0.026; odds ratio 2.9 (1.5, 7.6), whereas microbiological response (48% vs. 41%) and infection-related death rates (26% vs. 17%) were similar.…”

“…1 Resistance also affects the choice of 'targeted' therapy once a pathogen has been isolated, identified and subjected to susceptibility testing. In some cases, treatment options are very limited, and the emergence and proliferation of multiresistant Gram-negative organisms -both Enterobacteriaceae and non-fermenters -is forcing the renewed use of old antibiotics, notably colistin/polymyxin B and fosfomycin [2][3][4][5][6] and of tigecycline. Similarly, the emergence of Gram-positive pathogens resistant to β-lactams and glycopeptides is leading to the use of linezolid, daptomycin and tigecycline in hematology patients.…”