Yonsei Med J.  2014 Jan;55(1):118-125. 10.3349/ymj.2014.55.1.118.

Inhaled Colistin for Treatment of Pneumonia due to Colistin-Only-Susceptible Acinetobacter baumannii

• Choi HK
• Kim YK
• Kim HY
• Uh Y

• KMID: 1779895
• DOI: http://doi.org/10.3349/ymj.2014.55.1.118

Abstract

PURPOSE
Colistin is used for the treatment of pneumonia associated with multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa. However, the best route of administration and dosage is not known. We report our experience with aerosolized colistin in twelve patients with pneumonia caused by colistin-only-susceptible (COS) A. baumannii.
MATERIALS AND METHODS
We retrospectively reviewed patients' medical records who were treated with aerosolized colistin for the treatment of pneumonia.
RESULTS
Ten patients were treated only with aerosolized colistin inhalation and two patients received a 3-day course intravenous colistin, and then switched to colistin inhalation therapy. The median duration of aerosolized colistin therapy was 17 days (5-31 days). Four patients were treated only with aerosolized colistin, whereas 4 patients received concomitant glycopeptides, and 4 received concomitant levofloxacin or cefoperazone/sulbactam. At the end of the therapy, the clinical response rate and bacteriological clearance rate was 83% and 50%, respectively. Colistin-resistant strains were isolated from 3 patients after aerosolized colistin therapy; however, all of them showed favorable clinical response. The median interval between inhalation therapy and resistance was 7 days (range 5-19 days). Acute kidney injury developed in 3 patients. Two patients experienced Clostridium difficile associated diarrhea. One patient developed fever and skin rash after aerosolized colistin therapy. No patient developed neurotoxicity or bronchospasm.
CONCLUSION
Colistin inhalation therapy is deemed tolerable and safe, and could be beneficial as an adjuctive therapy for the management of pneumonia due to COS A. baumannii. However, the potential development of colistin resistance cannot be overlooked.

Keyword

Acinetobacter baumannii; colistin; pneumonia

MeSH Terms

Acinetobacter baumannii/drug effects/*pathogenicity
Administration, Inhalation
Aged
Anti-Bacterial Agents/administration & dosage/*therapeutic use
Colistin/administration & dosage/*therapeutic use
Female
Humans
Male
Middle Aged
Pneumonia/*drug therapy
Retrospective Studies
Anti-Bacterial Agents
Colistin

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