Colistin monotherapy versus therapy combination

Introduction

The purpose of our study was to compare the effectiveness of colistin monotherapy and colistin combination in the treatment of nosocomial infections with multi-resistant germs.

Methods

Retrospective study including 63 patients realized during 3 years from January 2006 to December 2008 in the medical ICU of University Hospital Ibn Rochd, Casablanca, Morocco. The study includes only the patients who suffer from nosocomial infection with multi-resistant germs, all of the sites are concerned. The patients have been divided into groups: group 1 including 30 patients treated by colistin only, and group 2 including 33 patients treated by the association colistin-rifampicin. The colistin has been administered intravenously and/or in nebulization and/or in an intrathecal way according to the considered infectious site. The main criterion of judgment was the rate of mortality in the resuscitation unit, the second criteria of judgment were the ventilator weaning, the introduction of the vasoactive drugs and the supervening of side effects.

Results

Sixty-three patients judged as appropriate, have been included. The mean age of the patients was about 43.62 ± 17.34 years and APACHE 2 score at the admission was about 15 ± 5.69. The total mortality caused by infection was about 41.27%. The basic characteristics of the two groups were similar. The mortality in group 1 was about 36.66%, and about 69.69% in group 2 (P = 0.001), the rate of introduction of vasoactive drugs was about 23.33% in group 1 versus 48.48% in group 2 (P = 0.03). In group 1, 6,66% of the patients developed renal failure, against 12.12% of the patients in group 2 (P = 0,46). With the rifampicin, 27.27% of the patients of group 2 presented cytolysis.

Conclusions

This study suggests that colistin represents a good therapeutic alternative for the treatment of nosocomial infection with multi-resistant germs. However, our study is not without limits; it is a retrospective study, absence of randomization and the control group of patients.