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.

1.
Llaca-Díaz JM, Mendoza-Olazarán S, Camacho-Ortiz A, Flores S, Garza-González E: One-year surveillance of ESKAPE pathogens in an intensive care unit of Monterrey, Mexico. Chemotherapy 2012;58:475-481.
2.
Garnacho-Montero J, Amaya-Villar R: Multiresistant Acinetobacter baumannii infections: epidemiology and management. Curr Opin Infect Dis 2010;23:332-339.
3.
Vila J, Pachón J: Therapeutic options for Acinetobacter baumannii infections. Expert Opin Pharmacother 2008;9:587-599.
4.
Montero A, Ariza J, Corbella X, Doménech A, Cabellos C, Ayats J, et al: Efficacy of colistin versus beta-lactams, aminoglycosides, and rifampin as monotherapy in a mouse model of pneumonia caused by multiresistant Acinetobacter baumannii. Antimicrob Agents Chemother 2002;46:1946-1952.
5.
Pachón-Ibáñez ME, Docobo-Pérez F, López-Rojas R, Domínguez-Herrera J, Jiménez-Mejias ME, García-Curiel A, et al: Efficacy of rifampin and its combinations with imipenem, sulbactam, and colistin in experimental models of infection caused by imipenem-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 2010;54:1165-1172.
6.
Levin AS, Barone AA, Penço J, Santos MV, Marinho IS, Arruda EA, et al: Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis 1999;28:1008-1011.
7.
Oliveira MS, Prado GVB, Costa SF, Grinbaum RS, Levin AS: Ampicillin/sulbactam compared with polymyxins for the treatment of infections caused by carbapenem-resistant Acinetobacter spp. J Antimicrob Chemother 2008;61:1369-1375.
8.
Paul M, Bishara J, Levcovich A, Chowers M, Goldberg E, Singer P, et al: Effectiveness and safety of colistin: prospective comparative cohort study. J Antimicrob Chemother 2010;65:1019-1027.
9.
Gordon NC, Png K, Wareham DW: Potent synergy and sustained bactericidal activity of a vancomycin-colistin combination versus multidrug-resistant strains of Acinetobacter baumannii. Antimicrob Agents Chemother 2010;54:5316-5322.
10.
Wareham DW, Gordon NC, Hornsey M: In vitro activity of teicoplanin combined with colistin versus multidrug-resistant strains of Acinetobacter baumannii. J Antimicrob Chemother 2011;66:1047-1051.
11.
Hornsey M, Wareham DW: In vivo efficacy of glycopeptide-colistin combination therapies in a Galleria mellonella model of Acinetobacter baumannii infection. Antimicrob Agents Chemother 2011;55:3534-3537.
12.
Calandra T, Cohen J: The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med 2005;33:1538-1548.
13.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818-829.
14.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992;101:1644-1655.
15.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
16.
Garonzik SM, Li J, Thamlikitkul V, Paterson DL, Shoham S, Jacob J, et al: Population pharmacokinetics of colistin methanesulfonate and formed colistin in critically ill patients from a multicenter study provide dosing suggestions for various categories of patients. Antimicrob Agents Chemother 2011;55:3284-3294.
17.
Tan TY, Ng LSY, Tan E, Huang G: In vitro effect of minocycline and colistin combinations on imipenem-resistant Acinetobacter baumannii clinical isolates. J Antimicrob Chemother 2007;60:421-423.
18.
Sopirala MM, Mangino JE, Gebreyes WA, Biller B, Bannerman T, Balada-Llasat J-M, et al: Synergy testing by Etest, microdilution checkerboard, and time-kill methods for pan-drug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother 2010;54:4678-4683.
19.
Santimaleeworagun W, Wongpoowarak P, Chayakul P, Pattharachayakul S, Tansakul P, Garey KW: In vitro activity of colistin or sulbactam in combination with fosfomycin or imipenem against clinical isolates of carbapenem-resistant Acinetobacter baumannii producing OXA-23 carbapenemases. Southeast Asian J Trop Med Public Health 2011;42:890-900.
20.
O'Hara JA, Ambe LA, Casella LG, Townsend BM, Pelletier MR, Ernst RK, et al: Activities of vancomycin-containing regimens against colistin-resistant Acinetobacter baumannii clinical strains. Antimicrob Agents Chemother 2013;57:2103-2108.
21.
Vidaillac C, Benichou L, Duval RE: In vitro synergy of colistin combinations against colistin-resistant Acinetobacter baumannii,Pseudomonas aeruginosa, and Klebsiella pneumoniae isolates. Antimicrob Agents Chemother 2012;56:4856-4861.
22.
Hornsey M, Longshaw C, Phee L, Wareham DW: In vitro activity of telavancin in combination with colistin versus Gram-negative bacterial pathogens. Antimicrob Agents Chemother 2012;56:3080-3085.
23.
Vaara M, Siikanen O, Apajalahti J, Fox J, Frimodt-Møller N, He H, et al: A novel polymyxin derivative that lacks the fatty acid tail and carries only three positive charges has strong synergism with agents excluded by the intact outer membrane. Antimicrob Agents Chemother 2010;54:3341-3346.
24.
Peleg AY, Jara S, Monga D, Eliopoulos GM, Moellering RC Jr, Mylonakis E: Galleria mellonella as a model system to study Acinetobacter baumannii pathogenesis and therapeutics. Antimicrob Agents Chemother 2009;53:2605-2609.
25.
Hornsey M, Phee L, Longshaw C, Wareham DW: In vivo efficacy of telavancin/colistin combination therapy in a Galleria mellonella model of Acinetobacter baumannii infection. Int J Antimicrob Agents 2013;41:285-287.
26.
Florescu DF, Qiu F, McCartan MA, Mindru C, Fey PD, Kalil AC: What is the efficacy and safety of colistin for the treatment of ventilator-associated pneumonia? A systematic review and meta-regression. Clin Infect Dis 2012;54:670-680.
27.
Matthaiou DK, Michalopoulos A, Rafailidis PI, Karageorgopoulos DE, Papaioannou V, Ntani G, et al: Risk factors associated with the isolation of colistin-resistant Gram-negative bacteria: a matched case-control study. Crit Care Med 2008;36:807-811.
28.
Michalopoulos AS, Tsiodras S, Rellos K, Mentzelopoulos S, Falagas ME: Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic. Clin Microbiol Infect 2005;11:115-121.
29.
Deryke CA, Crawford AJ, Uddin N, Wallace MR: Colistin dosing and nephrotoxicity in a large community teaching hospital. Antimicrob Agents Chemother 2010;54:4503-4505.
30.
Doshi NM, Mount KL, Murphy CV: Nephrotoxicity associated with intravenous colistin in critically ill patients. Pharmacotherapy 2011;31:1257-1264.
31.
Gauthier TP, Wolowich WR, Reddy A, Cano E, Abbo L, Smith LB: Incidence and predictors of nephrotoxicity associated with intravenous colistin in overweight and obese patients. Antimicrob Agents Chemother 2012;56:2392-2396.
32.
Falagas ME, Fragoulis KN, Kasiakou SK, Sermaidis GJ, Michalopoulos A: Nephrotoxicity of intravenous colistin: a prospective evaluation. Int J Antimicrob Agents 2005;26:504-507.
33.
Plachouras D, Karvanen M, Friberg LE, Papadomichelakis E, Antoniadou A, Tsangaris I, et al: Population pharmacokinetic analysis of colistin methanesulfonate and colistin after intravenous administration in critically ill patients with infections caused by Gram-negative bacteria. Antimicrob Agents Chemother 2009;53:3430-3436.
34.
Harigaya Y, Bulitta JB, Forrest A, Sakoulas G, Lesse AJ, Mylotte JM, et al: Pharmacodynamics of vancomycin at simulated epithelial lining fluid concentrations against methicillin-resistant Staphylococcus aureus (MRSA): implications for dosing in MRSA pneumonia. Antimicrob Agents Chemother 2009;53:3894-3901.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.