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Effectiveness and safety of colistin for the treatment of multidrug-resistant Pseudomonas aeruginosa infections

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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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Authors and Affiliations

  1. Dept. of Internal Medicine and Infectious Diseases, Hospital del Mar, Autonomous University of Barcelona, Paseo Marítimo 25-29, 08003, Barcelona, Spain

    M. Montero, J. P. Horcajada, L. Sorlí & H. Knobel

  2. Intensive Care Unit, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain

    F. Alvarez-Lerma

  3. Dept. of Pharmacy, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain

    S. Grau

  4. Health Services Evaluation and Clinical Epidemiology Dept., Hospital del Mar. CIBER de Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain

    M. Riu & M. Sala

Authors
  1. M. Montero
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  2. J. P. Horcajada
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  3. L. Sorlí
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  4. F. Alvarez-Lerma
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  5. S. Grau
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  6. M. Riu
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  7. M. Sala
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  8. H. Knobel
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Corresponding author

Correspondence to M. Montero.

Additional information

This study was presented at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), Mc Cormick Place Lakeside Center, Chicago, Illinois, that was held on September 17–20, 2007.

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Montero, M., Horcajada, J.P., Sorlí, L. et al. Effectiveness and safety of colistin for the treatment of multidrug-resistant Pseudomonas aeruginosa infections. Infection 37, 461–465 (2009). https://doi.org/10.1007/s15010-009-8342-x

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  • DOI: https://doi.org/10.1007/s15010-009-8342-x

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