title: Clinical efficacy and safety of the combination of colistin plus vancomycin for the treatment of severe infections caused by carbapenem-resistant Acinetobacter baumannii.
abstract: A potent synergy of a glycopeptide-colistin combination against Acinetobacter baumannii has recently been described. We set out to assess the efficacy and safety of this combination in a retrospective study including episodes of ventilator-associated pneumonia or bacteremia caused by carbapenem-resistant A. baumannii. We compared 29 patients (group I) treated with colistin plus vancomycin with 28 patients treated with colistin alone (group II). Group I received vancomycin (for empirical or targeted therapy) at the onset of colistin administration and both antimicrobials coincided for at least 5 days. Baseline characteristics, clinical cure, microbiological eradication, and mortality were similar in both groups but the rate of acute kidney injury was higher in group I (55.2 vs. 28%; p = 0.04). In critically ill patients with carbapenem-resistant A. baumannii infections, clinical outcomes do not differ in patients treated with colistin plus vancomycin from those receiving colistin without vancomycin. This combination significantly increases the risk of renal failure.
authors.affiliation: Unidad Clínica de Cuidados Críticos y Urgencias, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: Rosario
authors.initials: R
authors.lastname: Amaya-Villar
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez-Pizarraya
authors.forename: Esther
authors.initials: E
authors.lastname: Espejo-Gutiérrez de Tena
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Artero-González
authors.forename: Yael
authors.initials: Y
authors.lastname: Corcia-Palomo
authors.forename: Javier
authors.initials: J
authors.lastname: Bautista-Paloma
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000473:pathology; D040981:Acinetobacter baumannii / Q000187:drug effects; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015780:Carbapenems / Q000494:pharmacology; D003091:Colistin / Q000009:adverse effects / Q000627:therapeutic use*; D016638:Critical Illness; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D014640:Vancomycin; D003091:Colistin