nach oben

Erschienen in:

01.07.2007 | Original

Safety and efficacy of colistin compared with imipenem in the treatmentof ventilator-associated pneumonia: a matched case–control study

verfasst von: H. Kallel, L. Hergafi, M. Bahloul, A. Hakim, H. Dammak, H. Chelly, C. Ben Hamida, A. Chaari, N. Rekik, M. Bouaziz

Erschienen in: Intensive Care Medicine | Ausgabe 7/2007

Einloggen, um Zugang zu erhalten

Abstract

Objective

Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter baumanii.

Design

Pairwise, retrospective exposed–unexposed study.

Setting

Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia).

Patients

Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy.

Interventions

Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously.

Measurements and results

Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5 ± 3.8 days (range 5–22 days) with colistin and 8.9 ± 2.8 days (range 5–20 days) with imipenem (p = 0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p = 0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure.

Conclusions

We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.

Jones RN (2001) Resistance patterns among nosocomial pathogens: trends over the past few years. Chest 119:397S–404SCrossRefPubMed

Flournoy DJ, Reinert RL, Bell-Dixon C, Gentry CA (2000) Increasing antimicrobial resistance in gram-negative bacilli isolated from patients in intensive care units. Am J Infect Control 28:244–250CrossRefPubMed

Reina R, Estenssoro E, Saenz G, Canales HS, Gonzalvo R, Vidal G, Martins G, Das Neves A, Santander O, Ramos C (2005) Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort study. Intensive Care Med 31:1058–1065CrossRefPubMed

Falagas ME, Kasiakou SK (2006) Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Crit Care 10:R27CrossRefPubMedPubMedCentral

Olesen S, Madsen PO (1967) Intravenous administration of sodium colistimethate in urinary tract infections. Curr Ther Res Clin Exp 9:283–287PubMed

Price DJ, Graham DI (1970) Effects of large doses of colistin sulphomethate sodium on renal function. Br Med J 4:525–527CrossRefPubMedPubMedCentral

Tripathi VN, Stulberger EA, Takacs FJ (1970) Colistimethate overdosage. J Urol 104:176–178CrossRefPubMed

Devlieger H, Casteels-Van Daele M, Ki MB, Proesmans W (1977) Acute renal failure due to colistin intoxication. Acta Paediatr Belg 30:179–181PubMed

Levin AS, Barone AA, Penco J, Santos MV, Marinho IS, Arruda EA, Manrique EI, Costa SF (1999) Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumanii. Clin Infect Dis 28:1008–1011CrossRefPubMed

10.

Jimenez-Mejias ME, Becerril B, Marquez-Rivas FJ, Pichardo C, Cuberos L, Pachon J (2000) Successful treatment of multidrug-resistant Acinetobacter baumanii meningitis with intravenous colistin sulfomethate sodium. Eur J Clin Microbiol Infect Dis 19:970–971CrossRefPubMed

11.

Jimenez-Mejias ME, Pichardo-Guerrero C, Marquez-Rivas FJ, Martin-Lozano D, Prados T, Pachon J (2002) Cerebrospinal fluid penetration and pharmacokinetic/pharmacodynamic parameters of intravenously administered colistin in a case of multidrug-resistant Acinetobacter baumanii meningitis. Eur J Clin Microbiol Infect Dis 21:212–214CrossRefPubMed

12.

Stein A, Raoult D (2002) Colistin: an antimicrobial for the 21st century? Clin Infect Dis 35:901–902CrossRefPubMed

13.

Markou N, Apostolakos H, Koumoudiou C, Athanasiou M, Koutsoukou A, Alamanos I, Gregorakos L (2003) Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit Care 7:R78–83CrossRefPubMedPubMedCentral

14.

Ouderkirk JP, Nord JA, Turett GS, Kislak JW (2003) Polymyxin B nephrotoxicity and efficacy against nosocomial infections caused by multiresistant gram-negative bacteria. Antimicrob Agents Chemother 47:2659–2662CrossRefPubMedPubMedCentral

15.

Linden PK, Kusne S, Coley K, Fontes P, Kramer DJ, Paterson D (2003) Use of parenteral colistin for the treatment of serious infection due to antimicrobial-resistant Pseudomonas aeruginosa. Clin Infect Dis 37:e154–160CrossRefPubMed

16.

Garnacho-Montero J, Ortiz-Leyba C, Jimenez-Jimenez FJ, Barrero-Almodovar AE, Garcia-Garmendia JL, Bernabeu-WittelI M, Gallego-Lara SL, Madrazo-Osuna J (2003) Treatment of multidrug-resistant Acinetobacter baumanii ventilator-associated pneumonia (VAP) with intravenous colistin: a comparison with imipenem-susceptible VAP. Clin Infect Dis 36:1111–1118CrossRefPubMed

17.

Karabinis A, Paramythiotou E, Mylona-Petropoulou D, Kalogeromitros A, Katsarelis N, Kontopidou F, Poularas I, Malamou-Lada H (2004) Colistin for Klebsiella pneumonia-associated sepsis. Clin Infect Dis 38:e7–9CrossRefPubMed

18.

Falagas ME, Fragoulis KN, Kasiakou SK, Sermaidis GJ, Michalopoulos A (2005) Nephrotoxicity of intravenous colistin: a prospective evaluation. Int J Antimicrob Agents 26:504–507CrossRefPubMed

19.

20.

Kallel H, Bahloul M, Hergafi L, Akrout M, Ketata W, Chelly H, Hamida CB, Rekik N, Hammami A, Bouaziz M (2006) Colistin as a salvage therapy for nosocomial infections caused by multidrug-resistant bacteria in the ICU. Int J Antimicrob Agents. 28:366–369CrossRefPubMed

21.

Kallel H, Bahloul M, Ksibi H, Dammak H, Chelly H, Hamida CB, Chaari A, Rekik N, Bouaziz M (2005) Prevalence of hospital-acquired infection in a Tunisian hospital. J Hosp Infect 59:343–347CrossRefPubMed

22.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRefPubMed

23.

Marquette CH, Georges H, Wallet F, Ramon P, Saulnier F, Neviere R, Mathieu D, Rime A, Tonnel AB (1993) Diagnostic efficiency of endotracheal aspirates with quantitative bacterial cultures in intubated patients with suspected pneumonia. Comparison with the protected specimen brush. Am Rev Respir Dis 148:138–144CrossRefPubMed

24.

Dennesen PJ, van der Ven AJ, Kessels AG, Ramsay G, Bonten MJ (2001) Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med 163:1371–1375CrossRefPubMed

25.

Anon (2000) Methods for dilution antimicrobial susceptibility test for bacteria that grow aerobically. Approved standards document M7-A5. National Committee for Clinical Laboratory Standards, Wayne, PA, USA

26.

Anon (2000) Performance standard for antimicrobial susceptibility testing. Document M100-S10. National Committee for Clinical Laboratory Standards, Wayne, PA, USA

Titel: Safety and efficacy of colistin compared with imipenem in the treatmentof ventilator-associated pneumonia: a matched case–control study
verfasst von: H. Kallel
L. Hergafi
M. Bahloul
A. Hakim
H. Dammak
H. Chelly
C. Ben Hamida
A. Chaari
N. Rekik
M. Bouaziz
Publikationsdatum: 01.07.2007
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 7/2007
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0675-2

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Safety and efficacy of colistin compared with imipenem in the treatmentof ventilator-associated pneumonia: a matched case–control study