Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic

• Published in: Clinical microbiology and infection Vol. 11; no. 2; pp. 115 - 121
• Main Authors: Michalopoulos, A.S., Tsiodras, S., Rellos, K., Mentzelopoulos, S., Falagas, M.E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Elsevier Ltd 01-02-2005; Blackwell Science Ltd; Blackwell
• Subjects: Acinetobacter baumannii; Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; colistin; Colistin - adverse effects; Colistin - therapeutic use; Cross Infection - drug therapy; Drug Resistance, Multiple, Bacterial; Female; Gram-Negative Bacterial Infections - drug therapy; Humans; ICU-acquired infection; infection; Intensive Care Units; Male; Medical sciences; Middle Aged; nosocomial; Pharmacology. Drug treatments; Pseudomonas aeruginosa; Retrospective Studies; Pseudomonas aeruginosa; Acinetobacter baumannii; infection; nosocomial; ICU-acquired infection; colistin; Human; Colistin; Cyclic peptides; Intensive care unit; Infection; Antibiotic; Treatment; Polypeptide; Multiple resistance; Antibacterial agent; Gram negative bacteria
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1111/j.1469-0691.2004.01043.x

A retrospective case series study was performed in a 30-bed general intensive care unit (ICU) of a tertiary care hospital to assess the effectiveness and safety of colistin in 43 critically ill patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria. Various ICU-acquired infections, mainly pneumonia and bacteraemia caused by multiresistant strains of Pseudomonas aeruginosa and/or Acinetobacter baumannii, were treated with colistin. Good clinical response (cure or improvement) was noted in 74.4% of patients. Deterioration of renal function occurred in 18.6% of patients during colistin therapy. Nephrotoxicity was elevated significantly in those patients with a history of renal failure (62.5%). All-cause mortality amounted to 27.9%. In this group of critically ill patients, an age of >50 years (OR, 5.4; 95% CI 1.3–24.9) and acute renal failure (OR, 8.2; 95% CI 2.9–23.8) were independent predictors of mortality. Colistin should be considered as a treatment option in critically ill patients with infection caused by multiresistant Gram-negative bacilli.