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Abstract
BackgroundAcinetobacter baumannii has been associated with high morbidity and mortality rates, even in pediatric patients. Therapeutic options are limited, especially when the strain is multidrug resistant.MethodsClinical and microbiological analyses of 4 cases of systemic infections caused by multi drug resistant A. baumannii treated with colistin/vancomycin combination at a Pediatric Intensive Care Unit were performed in order to explore the potential synergistic activity of colistin plus vancomycin. All the patients were treated with colistin, meropenem and vancomycin.ResultsFour severe infections due to MDR A. baumannii were observed. All patients treated with colistin/vancomycin combination had a positive outcome with no infection relapses. Most importantly, no significant adverse events related to the simultaneous administration of COL plus VAN were observed. In our in-vitro experiments, the synergistic effect of the combination COL plus VAN showed an early bactericidal activity even at VAN concentration of 16 mg/L, which reflects the serum trough concentrations obtained in patients.DiscussionAn antimicrobial strategy based on the activity of colistin plus vancomycin was in-vitro and in-vivo effective in life-threatening infections caused by multidrug-resistant A. baumannii in a Pediatric Intensive Care Unit, in the absence of adverse effects. Colistin plus vancomycin were highly synergic and bactericidal against carbapenem-resistant, colistin sensitive A. baumannii whereas the addition of meropenem did not enhance the in-vitro activity of colistin plus vancomycin.ConclusionsOur results confirm existing data on the potential synergistic activity of a therapeutic strategy including colistin plus vancomycin and provide important new clinical information for its potential use as a therapeutic option against MDR A. baumannii infections, especially in the pediatric population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1133-3) contains supplementary material, which is available to authorized users.
Highlights
Acinetobacter baumannii has been associated with high morbidity and mortality rates, even in pediatric patients
Based on the potential synergistic activity of COL plus VAN, we report the in-vitro and in-vivo effectiveness of an antimicrobial strategy consisting of COL plus VAN plus meropenem (MEM) in four cases of systemic infections caused by multi-drug resistant (MDR) A. baumannii in a Pediatric Intensive Care Unit (PICU)
Over a 2-months period, four cases of systemic infections due to MDR A. baumannii treated with the combination colistin plus vancomycin in patients hospitalized at PICU of “Sapienza” University of Rome were observed
Summary
Acinetobacter baumannii has been associated with high morbidity and mortality rates, even in pediatric patients. Colistin (COL)-based combinations, with or without the addition of high dose of carbapenems, have been considered the milestone of the treatment; in consideration of the growing rate of resistance to several antimicrobial classes, innovative approaches against this microorganism have been investigated. Among these un-orthodox combinations, COL plus glycopeptides resulted to be effective both invitro and in animal models [10,11,12,13], with the potential additional advantage of preventing the development of COL resistance in COL sensitive strains [14, 15]
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