Treatment of Multidrug‐ResistantAcinetobacter baumanniiVentilator‐Associated Pneumonia (VAP) with Intravenous Colistin: A Comparison with Imipenem‐Susceptible VAP

Abstract

We prospectively evaluated the efficacy and toxicity of intravenously administered colistin in 35 episodes of ventilator-associated pneumonia (VAP) due to multidrug-resistant Acinetobacter baumannii. Microbiological diagnosis was performed with use of quantitative culture. In 21 patients, the episodes were caused by a strain susceptible exclusively to colistin (the CO group) and were all treated with this antimicrobial intravenously. In 14 patients, the episodes were caused by strains that remained susceptible to imipenem and were treated with imipenem-cilastatin (the IM group). Acute Physiology and Chronic Health Evaluation II scores at the time of admission and Sequential Organ Failure Assessment scores at time of diagnosis were similar in both groups. VAP was considered clinically cured in 57% of cases in both groups. In-hospital mortality rates were 61.9% in the CO group and 64.2% in the IM group, and the VAP-related mortality rates were 38% and 35.7%, respectively. Four patients in the CO group and 6 in the IM group developed renal failure. Neurophysiological evaluation was performed during 12 episodes in the CO group, but it revealed no signs of neuromuscular blockade. Intravenous colistin appears to be a safe and effective alternative to imipenem for the management of VAP due to carbapenem-resistant strains of A. baumannii.

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

“…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].…”

Subinhibitory concentrations of the cationic antimicrobial peptide colistin induce the pseudomonas quinolone signal in Pseudomonas aeruginosa

“…Despite their effectiveness, intravenous formulations of colistin (polymyxin E) and polymyxin B were gradually abandoned in most parts of the world in the early 1980s because of the reported high incidence of nephrotoxicity (Beringer, 2001;Brown et al, 1970). Recently, a number of studies have confirmed the safety of colistin and provided increased support for treatment of acute pulmonary infections caused by P. aeruginosa as well as infections caused by other multiresistant Gram-negative bacteria (Garnacho-Montero et al, 2003;Hanberger et al, 2001;Markou et al, 2003).…”

Colistín en infecciones nosocomiales por bacilos gramnegativos pan-resistentes

“…De la misma manera, las cifras son algo inferiores al 57% señalado por Garnacho-Montero y cols, en pacientes con NAVM o al 58% reportado por Levin y cols, para infecciones nosocomiales 8,9 . En un reporte previo, Beltrán y cols, describieron una tasa de respuesta favorable en 64,3% de 14 cursos de terapia, predominantemente en pacientes con neumonía, en dos unidades de Cuidados Intensivos (Libro de resú-menes, XXI Congreso Chileno de Infectología, 2004, Viña del Mar, Chile, CO-68).…”

“…La neurotoxicidad, expresada en forma de parestesias, bloqueo neuromuscular o apneas, fue considerada como la segunda reacción adversa en orden de importancia. Sin embargo, no se han reportado casos con este tipo de problemas desde la reintroducción de colistín, incluso a pesar de una búsqueda activa 8,23 .…”