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1 May 2003

Volume 36, Number 9
Clinical Infectious Diseases 2003;36:1111–1118
© 2003 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2003/3609-0003$15.00
DOI: 10.1086/374337
MAJOR ARTICLE

Treatment of Multidrug‐Resistant Acinetobacter baumannii Ventilator‐Associated Pneumonia (VAP) with Intravenous Colistin: A Comparison with Imipenem‐Susceptible VAP

J. Garnacho‐Montero,1

C. Ortiz‐Leyba,1

F. J. Jiménez‐Jiménez,1

A. E. Barrero‐Almodóvar1

J. L. García‐Garmendia,1

M. Bernabeu‐WittelI,2

S. L. Gallego‐Lara,1 and

J. Madrazo‐Osuna3

1Intensive Care Unit, 2Infectious Disease Service, and 3Neurophysiological Department, Hospital Universitario Virgen Del Rocio, Seville, Spain

We prospectively evaluated the efficacy and toxicity of intravenously administered colistin in 35 episodes of ventilator‐associated pneumonia (VAP) due to multidrug‐resistant Acinetobacter baumannii. Microbiological diagnosis was performed with use of quantitative culture. In 21 patients, the episodes were caused by a strain susceptible exclusively to colistin (the CO group) and were all treated with this antimicrobial intravenously. In 14 patients, the episodes were caused by strains that remained susceptible to imipenem and were treated with imipenem‐cilastatin (the IM group). Acute Physiology and Chronic Health Evaluation II scores at the time of admission and Sequential Organ Failure Assessment scores at time of diagnosis were similar in both groups. VAP was considered clinically cured in 57% of cases in both groups. In‐hospital mortality rates were 61.9% in the CO group and 64.2% in the IM group, and the VAP‐related mortality rates were 38% and 35.7%, respectively. Four patients in the CO group and 6 in the IM group developed renal failure. Neurophysiological evaluation was performed during 12 episodes in the CO group, but it revealed no signs of neuromuscular blockade. Intravenous colistin appears to be a safe and effective alternative to imipenem for the management of VAP due to carbapenem‐resistant strains of A. baumannii.

Received 22 July 2002; accepted 10 January 2003; electronically published 14 April 2003.

  • (See the editorial commentary by Kollef on pages 1119–21.)

Reprints or correspondence: Dr. José Garnacho‐Montero, Intensive Care Unit, Hospital Virgen Del Rocio, Av. Manuel Siurot s/n, 41013 Seville, Spain ().

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  • Financial Support: Departmental funds, Hospital Universitario Virgen Del Rocio, Seville, Spain.

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