Colistin-glycopeptide combination in critically ill patients with Gram negative infection: the clinical experience.
Antimicrob Agents Chemother. 2013 Nov 25;
Authors: Petrosillo N, Giannella M, Antonelli M, Antonini M, Barsic B, Belancic L, Inkaya AC, De Pascale G, Grilli E, Tumbarello M, Akova M
Colistin-glycopeptide combination (CGC) has been shown in vitro to be synergistic against multi-drug-resistant Gram negative bacteria (MDR-GNB), specially Acinetobacter baumannii, and to prevent further resistance. However, clinical data are lacking.We carried out a retrospective multicenter study of patients hospitalized in Intensive Care Units (ICUs) who received colistin for GNB infection over 1-year period, to assess the rates of nephrotoxicity and 30-day mortality, after treatment onset, among patients treated with and without CGC for ≥ 48 hours.Of the 184 patients treated with colistin, GNB infection was documented in 166. The main causative agents were: MDR A. baumannii (59.6%), MDR Pseudomonas aeruginosa (18.7%) and carbapenem-resistant Klebsiella pneumoniae (14.5%); in 16.9% of patients Gram positive bacteria (GPB) co-infection was documented. Overall, 68 patients (40.9%) received CGC. Comparison of patients treated with and without CGC showed significant differences for respiratory failure (39.7% vs. 58.2%), ventilator associated pneumonia (54.4% vs. 71.4%), MDR A. baumannii (70.6% vs. 52%) and GPB co-infection (41.2% vs. 0); there were no differences for nephrotoxicity (11.8% vs. 13.3%) and 30-day mortality (33.8% and 29.6%). Cox analysis, performed on patients who survived ≥ 5 days after treatment onset, showed Charlson index (HR 1.26, 95%CI 1.01-1.44, p=0.001) and MDR A. baumannii (HR 2.51, 95%CI 1.23-5.12, p=0.01) as independent predictors of 30-day mortality, whereas receiving CGC for ≥ 5 days was a protective factor (HR 0.42, 95%CI 0.19-0.93, p=0.03).We found that CGC was not associated with higher nephrotoxicity and was a protective factor for mortality if administered for ≥ 5 days.
PMID: 24277037 [PubMed - as supplied by publisher]Link to Article at PubMed