Tuberc Respir Dis.  2008 Jan;64(1):8-14. 10.4046/trd.2008.64.1.8.

Effects of Aerosol Colistin Treatment of Pneumonia Caused by Multi-drug Resistant Acinetobacter baumannii

• Choi HS
• Hwang YH
• Park MJ
• Kang HM

• KMID: 1478135
• DOI: http://doi.org/10.4046/trd.2008.64.1.8

Abstract

BACKGROUND: Acinetobacter infections are difficult to treat as they often exhibit multiple resistance to the antibiotics that are currently available for the treatment of pneumonia. Colistin is active against gram-negative bacteria, including the multiple drug resistant (MDR) Acinetobacter species. However, intravenous administration of colistin was abandoned because of its nephrotoxicity and neurotoxicity. The aims of this study were to examine the efficacy and safety of colistin administered by aerosol in the treatment of pneumonia caused by MDR Acinetobacter baumannii.
METHODS
We retrospectively reviewed the medical records of patients admitted to the intensive care unit (ICU) from Dec. 2006 to Aug. 2007 who had been diagnosed as suffering from pneumonia due to MDR Acinetobacter baumannii and had been treated with nebulized colistin.
RESULTS
31 patients received aerosolized colistin. The average duration of the treatment was 14+/-7 days and the daily dose of ranged from 225 mg to 300 mg. All patients received concomitant intravenous antimicrobial agents. The average length of the stay in the ICU was 34+/-21 days and in the hospital 58+/-52 days. The overall microbiological eradication was observed in 25 patients (80.6%). 14 of these (56%) were cured, and 11 (44%) were infected with other microorganisms. The overall crude mortality of the ICU was 48%. Nephrotoxicity and significant bronchial constriction did not occur in any patient during neublized colistin treatment.
CONCLUSION
Nebulized colistin may be a safe and effective option in the treatment of pneumonia due to MDR Acinetobacter baumannii. Its role in therapy warrants further investigation in comparative studies.

Keyword

Acinetobacter baumannii; Colistin neubulizer; Pneumonia

MeSH Terms

Acinetobacter
Acinetobacter baumannii
Acinetobacter Infections
Administration, Intravenous
Anti-Bacterial Agents
Anti-Infective Agents
Bronchoconstriction
Colistin
Gram-Negative Bacteria
Humans
Intensive Care Units
Medical Records
Pneumonia
Retrospective Studies
Stress, Psychological
Anti-Bacterial Agents
Anti-Infective Agents
Colistin

Reference

1. Bergogne-Berezin E. The increasing significance of outbreaks of Acinetobacter spp.: the need for control and new agents. J Hosp Infect. 1995. 30 Suppl:441–452.

2. Luna CM, Aruj PK. Nosocomial Acinetobacter pneumonia. Respirology. 2007. 12:787–791.

3. Cisneros-Herreros JM, Garnacho-Montero J, Pachon-Ibanez ME. Nosocomial pneumonia due to Acinetobacter baumannii. Enferm Infecc Microbiol Clin. 2005. 23 Suppl 3:46–51.

4. Diomedi A. Acinetobacter baumannii pandrug-resistant: update in epidemiological and antimicrobial managing issues. Rev Chilena Infectol. 2005. 22:298–320.

5. Trottier V, Namias N, Pust DG, Nuwayhid Z, Manning R, Marttos AC, et al. Outcomes of Acinetobacter baumannii infection in critically ill surgical patients. Surg Infect (Larchmt). 2007. 8:437–443.

6. Murray CK, Hospenthal DR. Treatment of multidrug resistant Acinetobacter. Curr Opin Infect Dis. 2005. 18:502–506.

7. Falagas ME, Kasiakou SK. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis. 2005. 40:1333–1341.

8. Beringer P. The clinical use of colistin in patients with cystic fibrosis. Curr Opin Pulm Med. 2001. 7:434–440.

9. Kwa AL, Loh C, Low JG, Kurup A, Tam VH. Nebulized colistin in the treatment of pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Clin Infect Dis. 2005. 41:754–757.

10. Michalopoulos A, Kasiakou SK, Mastora Z, Rellos K, Kapaskelis AM, Falagas ME. Aerosolized colistin for the treatment of nosocomial pneumonia due to multidrug-resistant Gram-negative bacteria in patients without cystic fibrosis. Crit Care. 2005. 9:R53–R59.

11. Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988. 138:720–723.

12. Wilks M, Wilson A, Warwick S, Price E, Kennedy D, Ely A, et al. Control of an outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus colonization and infection in an intensive care unit (ICU) without closing the ICU or placing patients in isolation. Infect Control Hosp Epidemiol. 2006. 27:654–658.

13. Ling ML, Ang A, Wee M, Wang GC. A nosocomial outbreak of multiresistant Acinetobacter baumannii originating from an intensive care unit. Infect Control Hosp Epidemiol. 2001. 22:48–49.

14. Hanberger H, Garcia-Rodriguez JA, Gobernado M, Goossens H, Nilsson LE, Struelens MJ. Antibiotic susceptibility among aerobic gram-negative bacilli in intensive care units in 5 European countries. French and Portuguese ICU Study Groups. JAMA. 1999. 281:67–71.

15. Paul M, Weinberger M, Siegman-Igra Y, Lazarovitch T, Ostfeld I, Boldur I, et al. Acinetobacter baumannii: emergence and spread in Israeli hospitals 1997-2002. J Hosp Infect. 2005. 60:256–260.

16. Park II, Kim IK, Koo HC, Han JP, Kim YM, Lee MG, et al. Clinical characteristics and prognosis of acinetobacter nosocomial pneumonia between MDR and non-MDR. Tuberc Respir Dis. 2006. 61:13–19.

17. Lee SW, Jo HS, Kim WJ. Clinical characteristics of intensive care unit patients with carbapenem resistant acinetobacter baumannii isolated from sputum. Tuberc Respir Dis. 2006. 60:228–234.

18. Saballs M, Pujol M, Tubau F, Peña C, Montero A, Domínguez MA, et al. Rifampicin/imipenem combination in the treatment of carbapenem-resistant Acinetobacter baumannii infections. J Antimicrob Chemother. 2006. 58:697–700.

19. Pereira GH, Muller PR, Levin AS. Salvage treatment of pneumonia and initial treatment of tracheobronchitis caused by multidrug-resistant Gram-negative bacilli with inhaled polymyxin B. Diagn Microbiol Infect Dis. 2007. 58:235–240.

20. Falagas ME, Kasiakou SK, Tsiodras S, Michalopoulos A. The use of intravenous and aerosolized polymyxins for the treatment of infections in critically ill patients: a review of the recent literature. Clin Med Res. 2006. 4:138–146.

21. Wood GC, Swanson JM. Aerosolised antibacterials for the prevention and treatment of hospital-acquired pneumonia. Drugs. 2007. 67:903–914.

22. Alothman GA, Ho B, Alsaadi MM, Ho SL, O'Drowsky L, Louca E, et al. Bronchial constriction and inhaled colistin in cystic fibrosis. Chest. 2005. 127:522–529.

23. Reina R, Estenssoro E, Saenz G, Canales HS, Gonzalvo R, Vidal G, et al. Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort study. Intensive Care Med. 2005. 31:1058–1065.

24. Lee MA, Moon HW. In vitro activity of antimicrobial combination against multidrug-resistant strains of acinetobacter baumannii. Korean J Lab Med. 2005. 25:312–316.