Safety and efficacy of colistin compared with imipenem in the treatment of ventilator-associated pneumonia: a matched case-control study.
OBJECTIVE
Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter baumanii.


METHODS
Pairwise, retrospective exposed-unexposed study.


METHODS
Combined medical and surgical intensive care unit of Habib Bourguiba University Hospital (Sfax, Tunisia).


METHODS
Sixty patients with VAP caused by pan-drug-resistant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy.


METHODS
Case patients were treated by colistin intravenously and control patients were treated by imipenem intravenously.


RESULTS
Baseline characteristics were similar between the colistin and imipenem groups. The mean duration of antibiotic therapy for VAP was 9.5+/-3.8 days (range 5-22 days) with colistin and 8.9+/-2.8 days (range 5-20 days) with imipenem (p=0.32). A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p=0.68). The time to resolution of infectious parameters after the initiation of antibiotic therapy was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal failure.


CONCLUSIONS
We conclude that colistin can be a safe and effective option in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.
Kallel
H
H
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia. kallelhat@yahoo.fr.
Hergafi
L
L
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
Bahloul
M
M
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
Hakim
A
A
Laboratoire de Pharmacologie, Faculté de Médecine de Sfax, route el Ain Km 1, 3029, Sfax, Tunisia.
Dammak
H
H
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
Chelly
H
H
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
Hamida
C Ben
CB
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
Chaari
A
A
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
Rekik
N
N
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
Bouaziz
M
M
Service de Réanimation Médicale, CHU Habib Bourguiba, route el Ain Km 1, 3029, Sfax, Tunisia.
D000151:Acinetobacter Infections / Q000188:drug therapy; D040981:Acinetobacter baumannii; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D003091:Colistin / Q000008:administration & dosage / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D007362:Intensive Care Units; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000209:etiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy*; D011552:Pseudomonas Infections / Q000188:drug therapy; D012189:Retrospective Studies; D013997:Time Factors
D000900:Anti-Bacterial Agents; D015378:Imipenem; D003091:Colistin