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Jang, Kim, Lee, Hong, Lim, and Koh: The Comparative Efficacy of Colistin Monotherapy and Combination Therapy Based on in vitro Antimicrobial Synergy in Ventilator-associated Pneumonia Caused by Multi-drug Resistant Acinetobacter baumannii
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(3): 212-220.

Published online: 30 September 2009

DOI: https://doi.org/10.4046/trd.2009.67.3.212

The Comparative Efficacy of Colistin Monotherapy and Combination Therapy Based on in vitro Antimicrobial Synergy in Ventilator-associated Pneumonia Caused by Multi-drug Resistant Acinetobacter baumannii

Hang Jea Jang, M.D.1, Mi-Na Kim, M.D.2, Kwangha Lee, M.D.1, Sang-Bum Hong, M.D.1, Chae-Man Lim, M.D.1, Younsuck Koh, M.D.1

1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Younsuck Koh, M.D., Ph.D. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap 2-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3134, Fax: 82-2-3010-4709, yskoh@amc.seoul.kr

Received 22 June 2009       Accepted 28 August 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Ventilator-associated pneumonia caused by multi-drug resistant Acinetobacter baumannii has been increasing and growing as a threat in intensive care units. Limited therapeutic options have forced clinicians to choose colistin with or without combination of other antibiotics. We tried to compare the effectiveness between colistin monotherapy and combination therapy based on in vitro synergistic tests.

Methods

From January 2006 to December 2007 in medical ICU of a tertiary care hospital in Korea, We reviewed the medical records of patients treated with intravenous colistin due to ventilator-associated pneumonia caused by multi-drug resistant Acinetobacter baumannii.

Results

A total of 41 patients were analyzed. 22 patients had been treated with colistin monotherapy and 19 patients with colistin and combination antibiotics that were found to have in vitro synergistic effects. Baseline characteristics were similar in both groups but the mean duration of colistin administration was significantly longer in the combination group (19.1±11.2 days vs. 12.3±6.8 days, p=0.042). There were no significant differences in outcome variables between the two groups.

Conclusion

Combination treatment based on the in vitro antimicrobial synergy test did not show better outcomes compared with colistin monotherapy in VAP caused by multi-drug resistant A. baumannii.

Keywords: Colistin, Acinetobacter baumannii, Multi-drug Resistance, Ventilator associated pneumonia, in vitro antimicrobial synergy

Figures and Tables

Table 1
Additional susceptibility results of the antibiotics involved in synergy test (n=28)
trd-67-212-i001
Table 2
The common antimicrobial combination showing synergistic effect by in vitro double disk synergy test
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Table 3
Antimicrobial combination patterns in colisitn+synergistic antibiotics group (n=19)
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Table 4
Comparison of baseline characteristics between two groups
trd-67-212-i004

ICU: intensive care unit; CPIS: clinical pulmonary infection score; VAP: ventilator-associated pneumonia.

*Previous: less than 4 weeks before onset of MDR A. baumannii ventilator-associated pneumonia.

Table 5
Outcomes of total patients and comparison between two groups
trd-67-212-i005

ICU: intensive care unit.

Table 6
Incidence of de novo nephrotoxicity after administration of colistin
trd-67-212-i006

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