Skip to main content

Efficacy of an intravenous colistin regimen in ventilator-associated pneumonia and bacteraemia due to multiresistant Gram-negative bacteria: preliminary results

Introduction

Colistin has been recently reintroduced in clinical practice, because of the increasing prevalence of multiresistant Gram-negative strains in ICUs. There is controversy on the efficacy of the drug provided either as monotherapy or in combination with β-lactams in critically ill patients with ventilator-associated pneumonia (VAP). We compared prospectively the efficacy and safety of administration of colistin alone and incombination with β-lactams in patients with VAP and bacteremia caused by multiresistant Gram-negative bacteria.

Patients and methods

Twelve patients (mean age: 57 ± 17 years) with VAP (quantitative cultures of tracheal aspirates of bronchoalveolar lavage [BAL]) and bacteraemia (at least one positive blood culture), caused by Pseudomonas aeruginosa (33%), Acinetobacter baumanii (58%) and/or Klebsiella pneumonia (25%), resistant to all antibiotics except colistin, were treated with intravenous colistin. Four of them (group A) received monotherapy with colistin (3 × 106 ssIU three times daily, adjusted for creatinine clearance) and eight of them received combination of colistin with cefepime, or piperacilline-tazobactam (group B). Follow-up cultures and clinical evaluation of all patients were performed 4 days after the initiation of therapy. Clinical success was defined by a lessening of the signs and symptoms of VAP, while microbiologic success was defined as eradication of the pathogen in blood culture.

Results

Follow-up blood cultures revealed microbiologic success in one patient from group A (25%) and four patients from group B (50%), but the difference was not statistically significant (P = 0.4). Eradication of the pathogen from tracheal aspirates or BAL was confirmed in the same patients. Clinical success followed microbiologic success in one patient from group A (25%) and five patients from group B (62.5%), difference not statistically significant (P = 0.3). One patient from group B developed acute renal failure and was treated with continuous venovenous hemofiltration (8%). No differences concerning mortality were observed between the two groups (group A: 100%, group B: 62.5%, P = 0.5).

Conclusion

Preliminary results demonstrate that combination therapy (colistin plus β-lactam) acts more effectively than monotherapy in VAP and bacteraemia from multiresistant Gram-negative strains. Colistin therapy in both groups was safe.

Author information

Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Frantzeskaki, F., Tsimogianni, A., Balla, M. et al. Efficacy of an intravenous colistin regimen in ventilator-associated pneumonia and bacteraemia due to multiresistant Gram-negative bacteria: preliminary results. Crit Care 10, P101 (2006). https://doi.org/10.1186/cc4448

Download citation

Keywords

  • Blood Culture
  • Pseudomonas Aeruginosa
  • Clinical Success
  • Colistin
  • Positive Blood Culture