Tuberc Respir Dis.  2009 Sep;67(3):212-220.

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

Affiliations
  • 1Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. yskoh@amc.seoul.kr
  • 2Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

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.

Keyword

Colistin; Acinetobacter baumannii; Multi-drug Resistance; Ventilator associated pneumonia; in vitro antimicrobial synergy
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