title: Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients.
abstract: BACKGROUND
  The increasing prevalence of multiresistant Gram-negative strains in intensive care units (ICUs) has recently rekindled interest in colistin, a bactericidal antibiotic that was used in the 1960s for treatment of infections caused by Gram-negative bacilli. We conducted the present observational study to evaluate the efficacy of intravenous colistin in the treatment of critically ill patients with sepsis caused by Gram-negative bacilli resistant to all other antibiotics.
  
  
  METHODS
  Critically ill patients with sepsis caused by Gram-negative bacilli resistant to all antibiotics with the exception of colistin were treated in the six-bed ICU of a trauma hospital. Diagnosis of infection was based on clinical data and isolation of bacteria, and the bacteria were tested with respect to their susceptibility to colistin. Clinical response to colistin was evaluated.
  
  
  RESULTS
  Twenty-four patients (mean age 44.3 years, mean Acute Physiology and Chronic Health Evaluation II score 20.6) received 26 courses of colistin. Clinical response was observed for 73% of the treatments. Survival at 30 days was 57.7%. Deterioration in renal function was observed in 14.3% of 21 patients who were not already receiving renal replacement therapy, but in only one case did this deterioration have serious clinical consequences.
  
  
  CONCLUSIONS
  The lack of a control group in the present study does not allow any definite conclusions to be drawn regarding the clinical effectiveness of colistin. On the other hand, this drug has an acceptable safety profile and its use should be considered in severe infections with multiresistant Gram-negative bacilli.
authors.affiliation: Intensive Care Unit B, Athens Trauma Hospital KAT, Athens, Greece. nikolaos_markou@hotmail.com
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Markou
authors.forename: Haralampos
authors.initials: H
authors.lastname: Apostolakos
authors.forename: Christiana
authors.initials: C
authors.lastname: Koumoudiou
authors.forename: Maria
authors.initials: M
authors.lastname: Athanasiou
authors.forename: Alexandra
authors.initials: A
authors.lastname: Koutsoukou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Alamanos
authors.forename: Leonidas
authors.initials: L
authors.lastname: Gregorakos
mesh_terms: D040981:Acinetobacter baumannii / Q000302:isolation & purification; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003091:Colistin / Q000008:administration & dosage*; D016638:Critical Illness; D018432:Drug Resistance, Multiple; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D018805:Sepsis / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin