Abstract
BackgroundThe increasing problem of infections due to multidrug-resistant Gram-negative bacteria has led to re-use of polymyxins in several countries. However, there are already clinical isolates of Gram-negative bacteria that are resistant to all available antibiotics, including polymyxins.MethodsWe present a case series of patients with infections due to pathogens resistant to all antimicrobial agents tested, including polymyxins. An isolate was defined as pandrug-resistant (PDR) if it exhibited resistance to all 7 anti-pseudomonal antimicrobial agents, i.e. antipseudomonal penicillins, cephalosporins, carbapenems, monobactams, quinolones, aminoglycosides, and polymyxins.ResultsClinical cure of the infection due to pandrug-resistant (PDR) Gram-negative bacteria, namely Pseudomonas aeruginosa or Klebsiella pneumoniae was observed in 4 out of 6 patients with combination of colistin and beta lactam antibiotics.ConclusionColistin, in combination with beta lactam antibiotics, may be a useful agent for the management of pandrug-resistant Gram-negative bacterial infections. The re-use of polymyxins, an old class of antibiotics, should be done with caution in an attempt to delay the rate of development of pandrug-resistant Gram-negative bacterial infections.
Highlights
The increasing problem of infections due to multidrug-resistant Gram-negative bacteria has led to re-use of polymyxins in several countries
The antibiotic recently regained some popularity in several countries as a salvage antimicrobial agent against bacteria resistant to all other classes of antibiotics
Design of the study – data collection Patients with infections caused by pandrug-resistant Gram-negative bacteria, who were hospitalized in the intensive care unit, during the period from 1/October/2000 to 31/ August/2004 were identified by the ICU's electronic database, and during the same period in hospital 2
Summary
The increasing problem of infections due to multidrug-resistant Gram-negative bacteria has led to re-use of polymyxins in several countries. There are already clinical isolates of Gram-negative bacteria that are resistant to all available antibiotics, including polymyxins. The incidence of multiresistant bacterial infections increases worldwide. This made the medical community to re-evaluate older agents such as colistin, for infections due to Gram-negative multiresistant bacteria, including Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. The antibiotic recently regained some popularity in several countries as a salvage antimicrobial agent against bacteria resistant to all other classes of antibiotics. BMC Infectious Diseases 2005, 5:24 http://www.biomedcentral.com/1471-2334/5/24 verify the high rates of toxicity of the medication reported domonal antimicrobial agents, including colistin.
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