title: Colistin in multi-drug resistant Pseudomonas aeruginosa blood-stream infections: a narrative review for the clinician.
abstract: Antimicrobial resistance to Pseudomonas aeruginosa is on the rise. In the absence of new anti-pseudomonal drugs, clinicians have had to resort to older antimicrobials such as colistin for the treatment of multi-drug resistant (MDR) strains. This polymyxin compound acts on the outer membrane of the bacteria resulting in its permeability and cell-death. Its bactericidal action is concentration-dependant. This antibiotic is mainly used as salvage therapy in the treatment of often life-threatening infections due to MDR P. aeruginosa blood-stream infections (BSI). Its potential nephrotoxicity and neurotoxicity have been overestimated and have limited the use in its intravenous form. A better understanding of its pharmacokinetics and pharmacodynamics, has facilitated more appropriate dosing strategies with a standard 9 million-unit daily-dose that should be adapted to kidney function. Combination treatment that involves the association of colistin with classical anti-pseudomonal treatment has rarely been clinically tested. In vitro synergy has been reported for certain combinations that could be used to prevent or limit the risk of induced resistance in MDR strains. Positioning colistin in antimicrobial strategies especially as a first-line treatment remains to be properly assessed.
authors.affiliation: Department of Internal Medicine, University Hospital of Nice - L'Archet, 151 Route de Saint-Antoine Ginestière, 06200 Nice, France. Electronic address: martis.n@chu-nice.fr.
authors.forename: Nihal
authors.initials: N
authors.lastname: Martis
authors.affiliation: Department of Respiratory Medicine, University Hospital of Nice - Pasteur, 30 Avenue de la Voie Romaine, 06000 Nice, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Leroy
authors.affiliation: Department of Medical Biology, Centre Hospitalier d'Antibes-Juan-les-Pins, 107 Avenue de Nice, 06606 Antibes, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Blanc
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy*; D003091:Colistin / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D011552:Pseudomonas Infections / Q000188:drug therapy*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000302:isolation & purification; D016879:Salvage Therapy / Q000379:methods
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin
keywords: Bacteraemia; Blood-stream infections; Colistimethate sodium; Colistin; Combination therapy; Dosing; Multi-drug resistance; Polymyxin; Pseudomonas aeruginosa; Strategy