Ventilator-associated pneumonia due to colistin susceptible-only microorganisms

Abstract

Acinetobacter spp. and Pseudomonas aeruginosa are common pathogens of ventilator-associated pneumonia (VAP). The presentation and outcome of VAP due to Acinetobacter spp. and P. aeruginosa susceptible to carbapenems (Carb-S; imipenem and/or meropenem) and to colistin only (Col-S) were compared in the present retrospective study in three intensive care units.A total of 61 episodes of VAP caused by Acinetobacter spp. or P. aeruginosa were studied, of which 30 isolates were Carb-S and 31 were Col-S.Demographics, worsening of renal function and mortality were not different. The univariate analysis showed that a later onset and a previous episode of VAP, prior antimicrobial therapy for .10 days and previous therapy with carbapenems during the present admission were more frequent in patients with Col-S strains. On multivariate analysis, prior antimicrobial therapy for .10 days and a previous episode of VAP remained significantly associated with Col-S VAP. Approximately 41% of the infections caused by Col-S isolates, but none of those due to Carb-S isolates, had received prior carbapenem therapy.Colistin-susceptible ventilator-associated pneumonia episodes can be effectively treated using colistin without significant renal dysfunction. This susceptibility pattern could be suspected in patients with a previous ventilator-associated pneumonia episode or prior antibiotic therapy for .10 days preceding the present ventilator-associated pneumonia episode.

Colistin as a first choice antibiotic for the initial empiric antimicrobial therapy of ventilator-associated pneumonia

“…According to our results, we had 50 Carb-S and only six Col-S isolates, which is a significant difference compared with the study by RIOS et al [1]. Also, only eight of the 50 Carb-S isolates were sensitive to imipenem but all 50 were meropenem sensitive (Mer-S).…”

“…Also, only eight of the 50 Carb-S isolates were sensitive to imipenem but all 50 were meropenem sensitive (Mer-S). Another difference with that study [1] is that 41 gentamicin-sensitive (Gent-S) isolates were identified.…”

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].…”

Bacteriological Aspects of Late Pneumonia in Ventilated Patient in Intensive Care Units: A Single Center Study in Morocco

“…This resistance profile lead in most of case, to using polymixine E (colistine) as the only efficient drug given by parenteral route and by aerosol to the MDRB infections especially Acinetobacter and Enterobacteriaceae producing carbapenemases [49][50][51][52]. Therefore, we recorded an increase incidence of bacterial species that are naturally resistant to polymyxin E (Proteus, Providencia, Serratia and Corynebacteria especially, multi-resistant one: Corynebacterium striatum).…”