Combined colistin and rifampicin therapy for carbapenem-resistant Acinetobacter baumannii infections: clinical outcome and adverse events

Petrosillo, Nicola; Chinello, Pierangelo; Proietti, M.; Cecchini, Luca; Masala, Marcello; Franchi, Cristiana; Venditti, Mario; Esposito, Silvano; Nicastri, Emanuele

doi:10.1111/j.1469-0691.2005.01198.x

Cited by 87 publications

(66 citation statements)

References 4 publications

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“…Microbiological eradication from the respiratory tract has proven even more difficult, with only 33% to 67% of cases being cleared of the pathogen (56,108,114). Given the lower response rates for respiratory tract infections and the in vitro synergy between colistin and rifampin, combination therapy has been used in a few patients (141,171). The combination of colistimethate and rifampin resulted in a microbiological clearance rate of 64% in patients with pneumonia due to multidrug-resistant A. baumannii infection (141).…”

Section: Clinical and Microbiological Outcomesmentioning

confidence: 99%

Polymyxins Revisited

et al. 2008

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SUMMARY The global emergence of multidrug-resistant gram-negative bacilli has spurred a renewed interest in polymyxins. Once discarded due to concerns regarding nephrotoxicity and neurotoxicity, polymyxins now hold an important role in the antibiotic armamentarium. However, more reliable information is needed to determine the optimal dosing of these agents. Also, unanswered questions regarding in vitro testing remain, including questions regarding the reliability of automated systems and the establishment of appropriate breakpoints for defining susceptibility. Most contemporary clinical studies examining the use of these agents have involved patients with infections due to multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains. It has been reassuring that polymyxin therapy for resistant bacteria has resulted in clinical responses and toxicity rates similar to those for carbapenem therapy for susceptible isolates. While most surveillance studies demonstrated high rates of susceptibility, several reports noted the emergence of polymyxin-resistant nosocomial pathogens. Polymyxins have assumed an important antibiotic niche for therapy for hospital-acquired infections; further studies defining the optimal use of these agents will likely extend the duration of their clinical usefulness.

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Section: Clinical and Microbiological Outcomesmentioning

confidence: 99%

Polymyxins Revisited

et al. 2008

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“…Los datos observados refutaron esta expectativa, aunque se debe considerar que el número de pacientes que no recibió terapia combinada fue bajo (< 20%) y que no hubo una randomización al comienzo del tratamiento. El uso de terapias combinadas junto con colistín u otras polimixinas, ha sido una constante en la literatura científica reciente, pero no ha sido testeada en estudios de tipo caso-control 21,22 . Por ejemplo, en una serie de 14 pacientes tratados con colistín y rifampicina, Petrosillo y cols, describen una respuesta favorable en 50% de casos de neumonía asociada a VM, algunos de ellos tratados, además, con sulbactam/ampicilina 22 .…”

Section: Discussionunclassified

“…El uso de terapias combinadas junto con colistín u otras polimixinas, ha sido una constante en la literatura científica reciente, pero no ha sido testeada en estudios de tipo caso-control 21,22 . Por ejemplo, en una serie de 14 pacientes tratados con colistín y rifampicina, Petrosillo y cols, describen una respuesta favorable en 50% de casos de neumonía asociada a VM, algunos de ellos tratados, además, con sulbactam/ampicilina 22 . Aún se requieren mayores estudios para aclarar esta posible ventaja terapéutica.…”

Section: Discussionunclassified

Colistín en infecciones nosocomiales por bacilos gramnegativos pan-resistentes

et al. 2007

Rev. chil. infectol.

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Emergence of panresistant gram negative bacilli has lead to the progressive reintroduction of intravenous colistin. Aim: To describe the clinical experience observed with this compound. Methodology: A retrospective analysis was performed for all treatments lasting > 48 hours. Medical records were analyzed to obtain clinical parameters and microbiological data, evaluate clinical response and evolution until discharge. Main results: 24 treatments lasting > 48 hours were applied between June 2005 and September 2006. Intravenous colistin was indicated to treat cases of ventilator-associated (VA) pneumonia (n = 10; 41.7%), abscess or collections (12.5%), bloodstream infections, non-VA pneumonia or urinary tract infections (4.2% each one, respectively). Treatment was initiated on average at 3.2 days (± 2.85) from diagnosis of infection. All courses were microbiologically-guided, and involved P. aeruginosa or A. baumannii isolates. Susceptibility was evaluated by E-test in 11 isolates (MIC 90 3.6 µg/mL, range 0.38 to 4 µg/mL). One isolate was resistant to colistin (9%). A favorable response was observed in 12 treatments (50%) with a relapse in 5 cases (41.7%). Being treated for pneumonia was the only factor associated to failure. (p = 0.04) Eradication was documented in 8 cases (33.3%) and persistence in 11 (45.8%). In 5 cases a microbiological follow-up was not available. Survival at time of discharge was 45.5%. (n = 10) None of the treatment courses was associated with nefrotoxicity. Conclusions: Intravenous colistin is a safe compound useful to treat various nosocomial infections due to pan-resistant gram negative bacilli. Nonetheless, its clinical efficacy is limited, especially among patients treated for nosocomial pneumonia.Key words: colistin, sepsis, Gram negative bacilli, panresistance. Palabras claves: colistín, bacilos gramnegativos, infecciones, pan-resistencia.Los datos epidemiológicos sobre la frecuencia de bacilos gramnegativos multi o pan-resistentes son escasos en el país, debido a que sólo recientemente se ha creado un sistema de vigilancia activo. Se trata, sin embargo, de un hecho progresivo radicado, especialmente, en las unidades de cuidados intensivos de hospitales de la Región Metropolitana. En el Hospital Clínico de la Universidad de Chile, la frecuencia de aislados de A. baumannii o P. aeruginosa pan-resistentes ha aumentado en forma constante desde el año 2004, motivando la importación de colistín para el manejo de estas infecciones.Colistín endovenoso es un fármaco de alto costo, no exento de toxicidad renal y carece de una evaluación rigurosa de su eficacia clínica. Por ejemplo, el costo diario de tratamiento con este antimicrobiano supera los 60 mil pesos chilenos (aproximadamente 120 U$). Habitualmente, los pacientes son tratados por 10 o más días. Introducciónas infecciones nosocomiales son un problema frecuente y se asocian a morbilidad, aumento de los costos y letalidad atribuible. Están asociadas a microorganismos multi o pan-resistentes que limitan, seriamente, las posibilidades de m...

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“…After the in vitro results showing the synergism of colistin with rifampicin, Petrosillo et al evaluated 14 patients taking such a combination, but there were no possible conclusions drawn at that time because 50 % of the patients died and there was no control group (Petrosillo et al, 2005). A similar study with 21 patients evaluated the same combination for ventilator associated pneumonia and bloodstream infection, with 100 % microbiological and clinical cure, but overall mortality was not evaluated (Motaouakkil et al, 2006a, b).…”

Section: Clinical Studies and Seriesmentioning

confidence: 99%