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Efficacy and safety of colistin in the treatment of infections in the ICU caused by multidrug-resistant Gram-negative organisms
© BioMed Central Ltd 2006
Published: 21 March 2006
The treatment of infections caused by multidrug-resistant (MDR) Gram-negative organisms poses a therapeutic challenge. With a diminishing armamentarium of effective new chemotherapeutic agents, there has been renewed interest in the polymyxins, which had fallen out of favour due to nephrotoxicity and neurotoxicity reported during their use in the 1960s.
Epidemiological analysis of the use of colistin in the treatment of MDR infections in an ICU.
Patients and methods
We prospectively recorded the clinical and microbiological efficacy, and safety profile of colistin (polymyxin E) in the treatment of MDR Gram-negative bacterial infections in an ICU, during a period of 18 months. Patients were treated with intravenous and/or aerosolized colistin.
Twenty-eight critically ill patients received a total of 33 courses of colistin administered in combination with another antimicrobial agent (mainly carbapenems or β-lactamase inhibitors). The patients' mean age was 66 years (range 29–84). Nineteen patients were male and nine female. Their mean APACHE II score was 18 (range 10–29). The infections treated were: 19 pneumonias (of which five had concurrent bacteremia), seven catheter-related bacteremias, three cases of peritonitis, one primary bacteremia, one infection of the catheter tip (without bacteremia) and one urinary tract infection. In one case the use of colistin was empirical. The responsible bacteria were Acinetobacter baumanii (47%), Pseudomonas aeruginosa (50%) and Klebsiella pneumonia (3%). The mean duration of colistin therapy was 14 days (range 2–36 days). The end of treatment mortality was 30%, and overall mortality at discharge was 48%. Nephrotoxicity was observed in two patients (7%) and neurotoxicity in one (3.5%). Both adverse events were reversible and had no serious outcomes.
Colistin in combination with other antimicrobials can be considered a reasonable and safe treatment option for MDR Gram-negative respiratory tract infections in the setting of limited therapeutic options.