title: Clinical and microbiological efficacy of colistin therapy alone or in combination as treatment for multidrug resistant Pseudomonas aeruginosa diabetic foot infections with or without osteomyelitis.
abstract: We retrospectively evaluated the safety and effectiveness of colistin alone or in combination with other antimicrobials in eight diabetic patients with severe diabetic foot infections due to multidrug resistant (MDR) Pseudomonas aeruginosa, complicated in 4 cases by osteomyelitis. All patients received colistin after other ineffective antimicrobial treatment, when MDR P. aeruginosa strains were isolated by cultural examination and together with a multidisciplinary care approach including revascularization, surgical debridement and adequate offloading. The mean duration of therapy was 72 +/- 52.9 days. Six out of 8 patients (75%) successfully benefited from colistin therapy, while 2 patients failed and/or experienced side effects that led to discontinuation of therapy. Serious adverse events (i.e. acute renal failure and pulmonary edema) were observed in 1 patient. Our data allow us to conclude that colistin, alone or in combination with other antimicrobials, is safe and effective when administered as part of a multidisciplinary approach, to promote healing of diabetic foot infection due to MDR P. aeruginosa.
authors.affiliation: Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. c.tascini@ao-pisa.toscana.it
authors.forename: C
authors.initials: C
authors.lastname: Tascini
authors.forename: G
authors.initials: G
authors.lastname: Gemignani
authors.forename: F
authors.initials: F
authors.lastname: Palumbo
authors.forename: A
authors.initials: A
authors.lastname: Leonildi
authors.forename: A
authors.initials: A
authors.lastname: Tedeschi
authors.forename: P
authors.initials: P
authors.lastname: Lambelet
authors.forename: A
authors.initials: A
authors.lastname: Lucarini
authors.forename: A
authors.initials: A
authors.lastname: Piaggesi
authors.forename: F
authors.initials: F
authors.lastname: Menichetti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D017719:Diabetic Foot / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D024901:Drug Resistance, Multiple, Bacterial; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D011552:Pseudomonas Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem; D012293:Rifampin; D003091:Colistin