Successful treatment of multidrug-resistant Pseudomonas aeruginosa meningitis with intravenous and intrathecal colistin

Schina, Maria; Spyridi, Evangelia; Daoudakis, Manolis; Mertzanos, Evripidis; Korfias, Stefanos

doi:10.1016/j.ijid.2005.03.005

Cited by 23 publications

(8 citation statements)

References 8 publications

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“…Clinical evidence for using only intravenous colistin for the treatment of MDR Gram-negative bacterial CNS infections remains controversial up to now [10,19,29]. For this reason, there is a low threshold for intrathecal therapy with colistin in patients having meningitis, and most of the published studies have shown good efficacy both in adults and children [10,15,19,23,28,38,40].…”

Section: Discussionmentioning

confidence: 99%

Colistin administration to pediatric and neonatal patients

Iosifidis¹,

Antachopoulos²,

Ioannidou³

et al. 2010

Eur J Pediatr

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Emergence of multidrug-resistant Gram-negative nosocomial pathogens has led to resurgence of colistin use. Safety and efficacy data regarding colistin use in pediatric patients are sparse, while optimal dosage has not been defined. We present a case series of neonates and children without cystic fibrosis treated with various doses of colistin intravenously. The records of patients who received colistin in a tertiary-care hospital from January 2007 to March 2009 were reviewed. Thirteen patients (median age 5 years, range 22 days to 14 years) received 19 courses of colistin as treatment of pneumonia, central nervous system infection, bacteremia, or complicated soft tissue infection. The isolated pathogens were Acinetobacter baumannii, Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Daily dose of colistin (colistimethate) ranged between 40,000 and 225,000 IU/kg. Duration of administration ranged from 1 to 133 days. Other antimicrobials were co-administered in 18/19 courses. Increase of serum creatinine in one patient was associated with co-administration of colistin and gentamicin. Sixteen of 19 courses had a favorable outcome, and only two of the three deaths were infection-related. Colistin intravenous administration appears well tolerated even at higher than previously recommended doses and of prolonged duration.

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Section: Discussionmentioning

confidence: 99%

Colistin administration to pediatric and neonatal patients

Iosifidis¹,

Antachopoulos²,

Ioannidou³

et al. 2010

Eur J Pediatr

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“…To overcome this problem, intrathecal or intraventricular delivery of polymyxins has generally been used in clinical practice and has become the only therapeutic option for the treatment of MDR GNB CNS infections that are resistant to all other antibiotics. Although most clinical experience with this administration route has been reported for infections caused by Acinetobacter baumannii, there are some reports of infections caused by MDR/XDR P. aeruginosa (226)(227)(228)(229)(230)(231)(232)(233) that have had good clinical outcomes. Even though the intrathecal route in this setting is mandatory, intrathecal polymyxin therapy has never been optimized according to PK/PD indices (225).…”

Section: Currently Available Antimicrobials For the Treatment Of Mdr mentioning

confidence: 99%

Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections

et al. 2019

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SUMMARYIn recent years, the worldwide spread of the so-called high-risk clones of multidrug-resistant or extensively drug-resistant (MDR/XDR)Pseudomonas aeruginosahas become a public health threat. This article reviews their mechanisms of resistance, epidemiology, and clinical impact and current and upcoming therapeutic options.In vitroandin vivotreatment studies and pharmacokinetic and pharmacodynamic (PK/PD) models are discussed. Polymyxins are reviewed as an important therapeutic option, outlining dosage, pharmacokinetics and pharmacodynamics, and their clinical efficacy against MDR/XDRP. aeruginosainfections. Their narrow therapeutic window and potential for combination therapy are also discussed. Other “old” antimicrobials, such as certain β-lactams, aminoglycosides, and fosfomycin, are reviewed here. New antipseudomonals, as well as those in the pipeline, are also reviewed. Ceftolozane-tazobactam has clinical activity against a significant percentage of MDR/XDRP. aeruginosastrains, and its microbiological and clinical data, as well as recommendations for improving its use against these bacteria, are described, as are those for ceftazidime-avibactam, which has better activity against MDR/XDRP. aeruginosa, especially strains with certain specific mechanisms of resistance. A section is devoted to reviewing upcoming active drugs such as imipenem-relebactam, cefepime-zidebactam, cefiderocol, and murepavadin. Finally, other therapeutic strategies, such as use of vaccines, antibodies, bacteriocins, anti-quorum sensing, and bacteriophages, are described as future options.

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“…The drug displays a concentration‐dependent bactericidal activity [122] and has recently been re‐introduced for the management of pulmonary infections in cystic fibrosis patients, either by the intravenous route or in the form of an aerosol [124], with lower rates of toxicity than reported previously [125]. A few studies, most of which are observational case series, have reported a favourable clinical response in various types of infections caused by multidrug‐resistant P. aeruginosa , including bacteraemia, pneumonia and meningitis [126–129]. In‐vitro studies also suggest that an association with rifampicin is synergic [130], but this observation needs to be further assessed in clinical settings [11].…”

Section: Current Therapeutic Optionsmentioning

confidence: 99%

Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium

Mesaros

Nordmann

Plésiat

et al. 2007

Clinical Microbiology and Infection

506

367

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Pseudomonas aeruginosa is a major cause of nosocomial infections. This organism shows a remarkable capacity to resist antibiotics, either intrinsically (because of constitutive expression of beta-lactamases and efflux pumps, combined with low permeability of the outer-membrane) or following acquisition of resistance genes (e.g., genes for beta-lactamases, or enzymes inactivating aminoglycosides or modifying their target), over-expression of efflux pumps, decreased expression of porins, or mutations in quinolone targets. Worryingly, these mechanisms are often present simultaneously, thereby conferring multiresistant phenotypes. Susceptibility testing is therefore crucial in clinical practice. Empirical treatment usually involves combination therapy, selected on the basis of known local epidemiology (usually a beta-lactam plus an aminoglycoside or a fluoroquinolone). However, therapy should be simplified as soon as possible, based on susceptibility data and the patient's clinical evolution. Alternative drugs (e.g., colistin) have proven useful against multiresistant strains, but innovative therapeutic options for the future remain scarce, while attempts to develop vaccines have been unsuccessful to date. Among broad-spectrum antibiotics in development, ceftobiprole, sitafloxacin and doripenem show interesting in-vitro activity, although the first two molecules have been evaluated in clinics only against Gram-positive organisms. Doripenem has received a fast track designation from the US Food and Drug Administration for the treatment of nosocomial pneumonia. Pump inhibitors are undergoing phase I trials in cystic fibrosis patients. Therefore, selecting appropriate antibiotics and optimising their use on the basis of pharmacodynamic concepts currently remains the best way of coping with pseudomonal infections.

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Successful treatment of multidrug-resistant Pseudomonas aeruginosa meningitis with intravenous and intrathecal colistin

Cited by 23 publications

References 8 publications

Colistin administration to pediatric and neonatal patients

Colistin administration to pediatric and neonatal patients

Epidemiology and Treatment of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Infections

Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium

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