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Colistin combination therapy improves microbiologic cure in critically ill patients with multi-drug resistant gram-negative pneumonia
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Colistin combination therapy improves microbiologic cure in critically ill patients with multi-drug resistant gram-negative pneumonia
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Journal Article
Colistin combination therapy improves microbiologic cure in critically ill patients with multi-drug resistant gram-negative pneumonia
2016
Overview
Currently,
in vitro
synergy with colistin has not translated into improved clinical outcomes. This study aimed to compare colistin combination therapy to colistin monotherapy in critically ill patients with multi-drug resistant gram-negative (MDR-GN) pneumonia. This was a retrospective analysis of critically ill adult patients receiving intravenous colistin for MDR-GN pneumonia comparing colistin combination therapy to colistin monotherapy with a primary endpoint of clinical cure. Combination therapy was defined by administration of another antibiotic to which the MDR-GN pathogen was reported as susceptible or intermediate. Ninety patients were included for evaluation (41 combination therapy and 49 monotherapy). Baseline characteristics were similar between groups. No difference in clinical cure was observed between combination therapy and monotherapy in univariate analysis, nor when adjusted for APACHE II score and time to appropriate antibiotic therapy (57.1 vs. 63.4 %, adjusted OR 1.15,
p
= 0.78). Microbiological cure was significantly higher for combination therapy (87 vs. 35.5 %,
p
< 0.001). Colistin combination therapy was associated with a significant improvement in microbiological cure, without improvement in clinical cure. Based on the
in vitro
synergy and improvement in microbiological clearance, colistin combination therapy should be prescribed for MDR-GN pneumonia. Further research is warranted to determine if
in vitro
synergy with colistin translates into improved clinical outcomes.
Publisher
Springer Berlin Heidelberg,Springer Nature B.V
Subject
/ Adult
/ Aged
/ Anti-Bacterial Agents - therapeutic use
/ Bacteria
/ Biomedical and Life Sciences
/ Drug Resistance, Multiple, Bacterial
/ Drug Therapy, Combination - methods
/ Female
/ Gram-Negative Bacteria - drug effects
/ Gram-Negative Bacteria - isolation & purification
/ Gram-Negative Bacterial Infections - drug therapy
/ Gram-Negative Bacterial Infections - microbiology
/ Gram-Negative Bacterial Infections - pathology
/ Humans
/ Male
/ Pharmacy
/ Pneumonia, Bacterial - drug therapy
/ Pneumonia, Bacterial - microbiology
