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Canadian Journal of Infectious Diseases and Medical Microbiology
Volume 19, Issue 6, Pages 413-418
http://dx.doi.org/10.1155/2008/743197
Original Article

Utilization of Colistin for Treatment of Multidrug-Resistant Pseudomonas aeruginosa

Deana M Sabuda,1,2 Kevin Laupland,1,3,4,5,6 Johann Pitout,4,6,7 Bruce Dalton,1,2 Harvey Rabin,3,6,7 Thomas Louie,3,6,7 and John Conly1,3,4,6,7

1Centre for Antimicrobial Resistance, Calgary Health Region, Calgary Laboratory Services, University of Calgary, Canada
2Pharmacy Services, Calgary Health Region, Canada
3Department of Medicine, University of Calgary, Calgary Laboratory Services, Calgary, Alberta, Canada
4Department of Pathology & Laboratory Medicine, University of Calgary, Calgary Laboratory Services, Calgary, Alberta, Canada
5Department of Critical Care Medicine, University of Calgary, Calgary Laboratory Services, Calgary, Alberta, Canada
6Institute of Infection, Immunity and Inflammation, University of Calgary, Calgary Laboratory Services, Calgary, Alberta, Canada
7Microbiology and Infectious Diseases, University of Calgary, Calgary Laboratory Services, Calgary, Alberta, Canada

Received 18 July 2008; Accepted 4 September 2008

Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

BACKGROUND: Colistin is uncommonly used in clinical practice; however, the emergence of multidrug-resistant organisms has rekindled interest in this potentially toxic therapeutic option. The present study describes the authors’ experience with colistin in the management of patients who were infected with metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa within the Calgary Health Region (Calgary, Alberta).

METHOD: Adult patients who received colistimethate sodium (colistin) between January 2000 and December 2005 were identified via pharmacy records, and their charts were reviewed retrospectively. Patients with cystic fibrosis were excluded. Patient demographics, clinical course and relevant laboratory data were extracted.

RESULTS: Twenty-eight courses of colistin were received by 22 patients. The majority of these treatments were directed at MBL-producing Pseudomonas. One-half of the patients received nebulized colistin. Intravenous (IV) colistin was administered to 12 patients for a mean ± SD of 14.7±13.8 days (range 3.7 to 46 days). The highest IV dose used was 125 mg every 6 h or 6 mg/kg/day. Eight of 12 patients (67%) treated with IV colistin responded either fully or partially. Two patients received IV colistin as outpatients. Adverse effects considered to be due to colistin included drug fever, nephrotoxicity and neurotoxicity. Five of nine patients (56%) who had complete data available for evaluation had at least a doubling of creatinine levels from baseline.

CONCLUSION: Patients in the present study received both IV and nebulized colistin for multidrug-resistant P aeruginosa. The use of IV colistin was associated with a favourable response, but mild nephrotoxicity occurred in two-third of patients. It was concluded that colistin may be a useful drug when choices are limited.