Use of Parenteral Colistin for the Treatment of Serious Infection Due to Antimicrobial-Resistant Pseudomonas aeruginosa

Abstract

Serious infection due to strains of Pseudomonas aeruginosa that exhibit resistance to all common antipseudomonal antimicrobials increasingly is a serious problem. Colistin was used as salvage therapy for 23 critically ill patients with multidrug-resistant P. aeruginosa infection. Twenty-two patients who had septic shock (n=14) and/or renal failure (n=21) received mechanical ventilatory support at baseline. The most common types of infection were pneumonia (n=18) and intra-abdominal infection (n=5). Colistin was administered for a median of 17 days (range, 7-36 days). Seven patients died during therapy, at a median of 17 days (range, 4-26 days) after initiation of treatment. A favorable clinical response was observed in 14 patients (61%); only 3 patients experienced relapse. Bacteremia was the only significant factor associated with treatment failure (P=.02). One patient manifested diffuse weakness that resolved after temporary cessation of colistin therapy. Colistin provides an important salvage therapeutic option for patients with otherwise untreatable serious P. aeruginosa infection.

Colistin efficacy in the treatment of multidrug-resistant and extremelydrug-resistant gram-negative bacterial infections*

“…Our study sample (n = 158) was larger than most of the previous ones and included critically ill patients who had been hospitalized (86.1%) in the ICU. The risk factors for clinical outcome were reported as bacteremia, acute respiratory distress syndrome, and high APACHE II score in previous studies (17)(18)(19)(20). In our study, multivariate analyses showed that underlying ultimately fatal disease, previous renal diseases, and total parenteral nutrition were important independent risk factors for worse clinical response.…”

Expression of ESBL, MBL and AmpC β lactamases by extra intestinal Escherichia coli isolates: correlation with treatment and clinical outcome

“…The only alternative may be the therapeutic administration of polymyxins, which has recently been shown to be efficient for treating multidrug-resistant gram negative bacilli. 22,23 In any case, these molecules should not be used in mono-therapy and rapid determination of MICs of aminoglycosides may help to choose an aminoglycoside molecule that may have some activity. Clearly, in the absence of novel agents in the near future, the spread of MBL producers may lead to therapeutic dead ends.…”

A randomized, placebo-controlled phase I study assessing the safety and immunogenicity of aPseudomonas aeruginosahybrid outer membrane protein OprF/I vaccine (IC43) in healthy volunteers

“…6 Serious infection due to strains of Pseudomonas aeruginosa that exhibit resistance to common antipseudomonal antimicrobials is an increasingly serious problem. 7 Fourteen percent of P. aeruginosa isolates are multi-drug resistant and some isolates from cystic fibrosis patients are resistant to all antibiotics approved by the United States Food and Drug Administration. 4 Therefore, other approaches for the prevention and cure of P. aeruginosa infections are required.…”

“…5,[8][9][10][11][12][13] In gram-negative bacteria lipopolysaccharides and outer membrane proteins are the major antigenic components of the bacterial envelope. Because lipopolysaccharide-based vaccines might cause systemic adverse reactions, 14 due to systemic inflammation after parenteral injection, 7 outer membrane protein-based vaccines with an acceptable toxicity profile are attractive clinical development candidates. P. aeruginosa-specific outer membrane proteins are structurally conserved among all known serotypes and still present after phenotypic conversion by overexpression of alginate to mucoid strains, a marker for the onset of chronic lung infection in CF patients.…”