Colistín en infecciones nosocomiales por bacilos gramnegativos pan-resistentes

Rev Chil Infect 2007 V.24 N.5 P.360-367

Alberto Fica C., Ignacio Céspedes J., Macarena Gompertz G., Mauricio Jalón V., Andrea Sakurada Z. y Enzo Sáez L.

Hospital Clínico Universidad de Chile, Santiago, Chile Sección de Infectología (AFC) Departamento de Medicina (ICJ, MGG, MJV) Laboratorio Central (ASZ) Unidad de Pacientes Críticos (ESL)

Emergence of panresistant gram negative bacilli has lead to the progressive reintroduction of intravenous colistin. Aim: To describe the clinical experience observed with this compound. Methodology: A retrospective analysis was performed for all treatments lasting > 48 hours. Medical records were analyzed to obtain clinical

parameters and microbiological data, evaluate clinical response and evolution until discharge. Main results: 24 treatments lasting > 48 hours were applied between June 2005 and September 2006. Intravenous colistin was indicated to treat cases of ventilator-associated (VA) pneumonia (n = 10; 41.7%), abscess or collections (12.5%), bloodstream infections, non-VA pneumonia or urinary tract infections (4.2% each one, respectively). Treatment was initiated on average at 3.2 days (± 2.85) from diagnosis of infection. All courses were microbiologically-guided, and involved P. aeruginosa or A. baumannii isolates. Susceptibility was evaluated by E-test in 11 isolates (MIC90 3.6 μg/mL, range 0.38 to 4 μg/mL). One isolate was resistant to colistin (9%). A favorable response was observed in 12 treatments (50%) with a relapse in 5 cases (41.7%). Being treated for pneumonia was the only factor associated to failure. (p = 0.04) Eradication  was documented in 8 cases (33.3%) and persistence in 11 (45.8%). In 5 cases a microbiological follow-up was not available. Survival at time of discharge was 45.5%. (n = 10) None of the treatment courses was associated with nefrotoxicity. Conclusions:

Intravenous colistin is a safe compound useful to treat various nosocomial infections due to pan-resistant gram negative bacilli. Nonetheless, its clinical efficacy is limited, especially among patients treated for nosocomial pneumonia.

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