Effectiveness and Safety of Colistin for the Treatment of Multidrug-resistant Pseudomonas Aeruginosa Infections

Overview

Journal Infection

Date 2009 Jun 6

PMID 19499183

Citations 35

Authors

M Montero

J P Horcajada

L Sorli

F Alvarez-Lerma

S Grau

M Riu

M Sala

H Knobel

Affiliations

Soon will be listed here.

Abstract

Purpose: To describe the clinical and microbiological outcomes of patients infected with multidrug-resistant Pseudomonas aeruginosa (MDRP) treated with colistin (colistimethate sodium) and the adverse events observed with this treatment.

Methods: Retrospective study of MDRP infections treated with colistin from 1997 to 2006.

Results: 121 episodes were identified. The median daily intravenous dose was 240 mg/day; 28.9% of patients received intravenous and nebulized colistin. Clinical outcome was favorable in ten cases of bacteremia (62.5%, n = 16), 43 cases of bronchial infection (72.9%, n = 59), 13 cases of pneumonia (65%, n = 20), 11 cases of urinary infection (84.6%, n = 13), eight cases of skin and soft tissues (72.7%, n = 11), and in the one case of arthritis and one case of otitis. Eradication was achieved in 31 (34.8%) of the 89 patients with available bacteriologic data. Factors associated with bacteriological failure were smoking, chronic obstructive pulmonary disease (COPD), and previous infection with P. aeruginosa. Nephrotoxicity occurred in ten cases (8.3%), with the associated factors being previous chronic renal insufficiency, diabetes mellitus, and aminoglycoside use. Crude mortality was 16.5%, and related MDRP was 12.4%, and was higher in patients with pneumonia or bacteremia (36.1%) than in other types of infections (8.2%).

Conclusions: Colistin is a safe option for the treatment of MDRP infections, with acceptable clinical outcomes. However, bacteriological eradication is difficult to achieve, especially in COPD patients.

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References

Bukholm G, Tannaes T, Kjelsberg A, Smith-Erichsen N . An outbreak of multidrug-resistant Pseudomonas aeruginosa associated with increased risk of patient death in an intensive care unit. Infect Control Hosp Epidemiol. 2002; 23(8):441-6. DOI: 10.1086/502082. View

Naranjo C, Busto U, Sellers E, Sandor P, Ruiz I, Roberts E . A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30(2):239-45. DOI: 10.1038/clpt.1981.154. View

Landman D, Georgescu C, Martin D, Quale J . Polymyxins revisited. Clin Microbiol Rev. 2008; 21(3):449-65. PMC: 2493081. DOI: 10.1128/CMR.00006-08. View

Conway S, Pond M, Watson A, Etherington C, Robey H, Goldman M . Intravenous colistin sulphomethate in acute respiratory exacerbations in adult patients with cystic fibrosis. Thorax. 1998; 52(11):987-93. PMC: 1758447. DOI: 10.1136/thx.52.11.987. View

Petrosillo N, Ioannidou E, Falagas M . Colistin monotherapy vs. combination therapy: evidence from microbiological, animal and clinical studies. Clin Microbiol Infect. 2008; 14(9):816-27. DOI: 10.1111/j.1469-0691.2008.02061.x. View

Falagas M, Kasiakou S . Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis. 2005; 40(9):1333-41. DOI: 10.1086/429323. View

Hogg G, Barr J, Webb C . In-vitro activity of the combination of colistin and rifampicin against multidrug-resistant strains of Acinetobacter baumannii. J Antimicrob Chemother. 1998; 41(4):494-5. DOI: 10.1093/jac/41.4.494. View

Michalopoulos A, Tsiodras S, Rellos K, Mentzelopoulos S, Falagas M . Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic. Clin Microbiol Infect. 2005; 11(2):115-21. DOI: 10.1111/j.1469-0691.2004.01043.x. View

Koomanachai P, Tiengrim S, Kiratisin P, Thamlikitkul V . Efficacy and safety of colistin (colistimethate sodium) for therapy of infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii in Siriraj Hospital, Bangkok, Thailand. Int J Infect Dis. 2007; 11(5):402-6. DOI: 10.1016/j.ijid.2006.09.011. View

10.

Reina R, Estenssoro E, Saenz G, Canales H, Gonzalvo R, Vidal G . Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort study. Intensive Care Med. 2005; 31(8):1058-65. DOI: 10.1007/s00134-005-2691-4. View

11.

Falagas M, Bliziotis I, Kasiakou S, Samonis G, Athanassopoulou P, Michalopoulos A . Outcome of infections due to pandrug-resistant (PDR) Gram-negative bacteria. BMC Infect Dis. 2005; 5:24. PMC: 1087841. DOI: 10.1186/1471-2334-5-24. View

12.

Oie S, Uematsu T, Sawa A, Mizuno H, Tomita M, Ishida S . In vitro effects of combinations of antipseudomonal agents against seven strains of multidrug-resistant Pseudomonas aeruginosa. J Antimicrob Chemother. 2003; 52(6):911-4. DOI: 10.1093/jac/dkg478. View

13.

Falagas M, Rizos M, Bliziotis I, Rellos K, Kasiakou S, Michalopoulos A . Toxicity after prolonged (more than four weeks) administration of intravenous colistin. BMC Infect Dis. 2005; 5:1. PMC: 547910. DOI: 10.1186/1471-2334-5-1. View

14.

Falagas M, Kasiakou S, Tsiodras S, Michalopoulos A . The use of intravenous and aerosolized polymyxins for the treatment of infections in critically ill patients: a review of the recent literature. Clin Med Res. 2006; 4(2):138-46. PMC: 1483888. DOI: 10.3121/cmr.4.2.138. View

15.

Markou N, Apostolakos H, Koumoudiou C, Athanasiou M, Koutsoukou A, Alamanos I . Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit Care. 2003; 7(5):R78-83. PMC: 270720. DOI: 10.1186/cc2358. View

16.

Falagas M, Kasiakou S . Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Crit Care. 2006; 10(1):R27. PMC: 1550802. DOI: 10.1186/cc3995. View

17.

Kallel H, Bahloul M, Hergafi L, Akrout M, Ketata W, Chelly H . Colistin as a salvage therapy for nosocomial infections caused by multidrug-resistant bacteria in the ICU. Int J Antimicrob Agents. 2006; 28(4):366-9. DOI: 10.1016/j.ijantimicag.2006.07.008. View

18.

Rynn C, Wootton M, Bowker K, Holt H, Reeves D . In vitro assessment of colistin's antipseudomonal antimicrobial interactions with other antibiotics. Clin Microbiol Infect. 2002; 5(1):32-36. DOI: 10.1111/j.1469-0691.1999.tb00095.x. View

19.

Schindler M, Osborn M . Interaction of divalent cations and polymyxin B with lipopolysaccharide. Biochemistry. 1979; 18(20):4425-30. DOI: 10.1021/bi00587a024. View

20.

Giamarellos-Bourboulis E, Sambatakou H, Galani I, Giamarellou H . In vitro interaction of colistin and rifampin on multidrug-resistant Pseudomonas aeruginosa. J Chemother. 2003; 15(3):235-8. DOI: 10.1179/joc.2003.15.3.235. View