Colistin in the treatment of severely burned patients infected by multiresistant strains of Pseudomonas aeruginosa
Authors:
B. Lipový 1; H. Řihová 1; M. Hanslianová 2; N. Gregorová 1; Y. Kaloudová 1; R. Mager 1; I. Suchánek 1; P. Brychta 1
Authors‘ workplace:
Klinika popálenin a rekonstrukční chirurgie FN Brno
1; Oddělení klinické mikrobiologie FN Brno
2
Published in:
Epidemiol. Mikrobiol. Imunol. 59, 2010, č. 4, s. 183-188
Overview
Study objectives:
To evaluate colistin as monotherapy or combination therapy in infections caused by multiresistant strains of Gram-negative bacteria. To point out the upward trend in the resistance of Gram-negative bacteria in burn patients. To underline that colistin therapy is often the only and relative safe therapeutic option for patients infected with multiresistant strains of Pseudomonas aeruginosa. Polymyxins as a family of antibiotics were discovered in the late 1940s. Only polymyxin B and polymyxin E (colistin) were introduced into clinical practice. Their use was substantially reduced in the 1980s due to multiple studies that had revealed their nephrotoxicity and neurotoxicity and the indication was limited to complicated Gram-negative infections of the lower respiratory tract in patients with cystic fibrosis and to topical use of polymyxin B. At the beginning of the new millennium, colistin is enjoying a revival because of the increase in resistance of Gram-negative bacteria, namely Pseudomonas aeruginosa and Acinetobacter baumannii.
Study type:
Retrospective, monocentric.
Settings:
Clinic of Burns and Reconstructive Surgery, University Hospital Brno, Department of Clinical Microbiology, University Hospital Brno.
Material and methods:
Twenty-two patients (7 females) with a 37% mean total body surface area (TBSA) of burn (TBSA range 17–82%) treated with colistin were enrolled in the study. The mean length of hospital stay was 49 days (range 32–149 days) and the mean age was 35.5 years (range 18–66 years). In all patients, colistin was used for the treatment of infections caused by multiresistant strains of Pseudomonas aeruginosa, i.e. the strains resistant to at least three of five families of anti-Pseudomonas antibiotics (anti-Pseudomonas penicillins, cephalosporins, aminoglycosides, fluoroquinolones and carbapenems).
Results:
In 2007–2009, a total of 167 patients (48 females) were admitted to the intensive care unit (ICU) of the Clinic of Burns and Reconstructive Surgery, University Hospital Brno. When hospitalized, 59 patients (35.3 %) were culture positive for Pseudomonas aeruginosa and 31 patients (18.6 %) had multiresistant strains of Pseudomonas aeruginosa. In the indicated period, 22 patients (13.2 %) received colistin, 7 as systemic therapy and 15 as topical therapy. The mean length of colistin therapy was 16.7 days (range 11–25 days). None of the patients developed any adverse events while on colistin. Three patients on colistin died but no death was caused by any colistin-related adverse event. Due to the low clinical effect of colistin monotherapy in five patients, three patients were switched to the combination therapy colistin + meropenem and two patients were switched to colistin + cefoperazone + sulbactam. Colistin monotherapy was effective in 14 (63.6 %) of 22 patients.
Conclusion:
A considerable increase in resistance of Gram-negative bacteria has been observed in the last decade. Pseudomonas aeruginosa is the leading hospital pathogen in this group causing the highest mortality worldwide. As there is no prospect of a novel family of anti-Pseudomonas antibiotics appearing on the market in the foreseeable future, we have to look backwards at polymyxins while considering the available therapeutic options.
Key words:
colistin – Pseudomonas aeruginosa – resistance – burns.
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Hygiene and epidemiology Medical virology Clinical microbiologyArticle was published in
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