Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic

Abstract

A retrospective case series study was performed in a 30-bed general intensive care unit (ICU) of a tertiary care hospital to assess the effectiveness and safety of colistin in 43 critically ill patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria. Various ICU-acquired infections, mainly pneumonia and bacteraemia caused by multiresistant strains of Pseudomonas aeruginosa and/or Acinetobacter baumannii, were treated with colistin. Good clinical response (cure or improvement) was noted in 74.4% of patients. Deterioration of renal function occurred in 18.6% of patients during colistin therapy. Nephrotoxicity was elevated significantly in those patients with a history of renal failure (62.5%). All-cause mortality amounted to 27.9%. In this group of critically ill patients, an age of >50 years (OR, 5.4; 95% CI 1.3-24.9) and acute renal failure (OR, 8.2; 95% CI 2.9-23.8) were independent predictors of mortality. Colistin should be considered as a treatment option in critically ill patients with infection caused by multiresistant Gram-negative bacilli.

Antimicrobial susceptibility of Acinetobacter baumannii isolated from hospital patients

“…Similar data obtained from studies from Chiang Mai University Hospital in Northern Thailand indicate that colistin has a higher activity against A. baumannii than cefoperazone/sulbactam or imipenem (out of 132 A. baumannii isolates, 96%, 77%, and 64% were susceptible to colistin, cefoperazone/sulbactam, and imipenem, respectively) 16 . The result of clinical effectiveness of colistin monotherapy and combination therapy suggested that colistin alone achieves cure and/or improvement rates ranging from 57% to 78% 17,18 , whereas the equivalent rates for combination therapy showed 67% to 74% 18 .…”

“…Nephrotoxicity is a major concern when colistin is administered in patients with a history of chronic renal failure 17 . Colistin combination therapy is being strongly recommended against monotherapy due to selection of heteroresistant strains during prolonged colistin therapy 22 and heteroresistance strains were reported to be correlated with endemic infections in ICU 23 .…”

Colistin therapy for microbiologically documented multidrug-resistant Gram-negative bacterial infections: a retrospective cohort study of 258 patients

“…Only the first episode of MDR Gram-negative bacterial infection M a n u s c r i p t treated with colistin was included in the analysis. An a priori decision was made not to remove from this analysis patients who received care during the period October 2000 to May 2005 for whom a subset of data has been reported previously [5][6][7]. Specifically, some data on 108 patients included in this analysis have been previously reported.…”

“…polymyxins (colistin and polymyxin B), an antibiotic class discovered more that 60 years ago that had been abandoned for nearly 20 years, except for in the distinct population of patients with cystic fibrosis [2]. A number of recently published clinical studies have suggested that colistin may be considered in the treatment of patients with MDR Gram-negative bacterial infections [3][4][5][6][7][8][9].…”

Type, course and outcome of community acquired infections in hospitalized diabetics

“…[9][10][11] In Mediterranean countries, there is an assumption that the management of infections is challenging because of the excessive use of antibiotics and of the prevalence of multidrug resistant bacteria (MDR) [12][13][14] which often requires the use of pharmaceutic agents which are potentially toxic. 15,16 In other countries, community acquired bacteria resistant to antibiotics are already considered a major public concern. 17 However, published data regarding the type of infections due to MDR, especially of a serious nature such as bacteremia, are scarce.…”