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      Intra-Pleural Colistin Methanesulfonate Therapy for Pleural Infection caused by Carbapenem-Resistant Acinetobacter Baumannii: A Successful Case Report

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          Abstract

          Infections caused by carbapenem-resistant, Gram-negative bacteria are an increasing clinical challenge, since the antimicrobial treatment options are often limited to colistin methanesulfonate. No data are available regarding the pharmacokinetics of colistin in pleural fluid. We report the case of a 92-year old man with ventilator-associated pneumonia and pleurisy caused by Acinetobacter baumannii and Escherichia coli, which were both multidrug-resistant. After an unsuccessful treatment with intravenous colistin methanesulfonate and imipen-em-cilastatin, the addition of intra-pleural colistin methanesulfonate to the intravenous treatment led to a prompt clinical, radiological and microbiological resolution. This is the first report of a successful use of intra-pleural colistin in the literature. The intra-pleural colistin therapy should be considered in selected cases of pleurisy caused by multi-resistant Gram-negative bacteria.

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          Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections.

          Matthew E. Falagas, Sofia Kasiakou (2005)
          The emergence of multidrug-resistant gram-negative bacteria and the lack of new antibiotics to combat them have led to the revival of polymyxins, an old class of cationic, cyclic polypeptide antibiotics. Polymyxin B and polymyxin E (colistin) are the 2 polymyxins used in clinical practice. Most of the reintroduction of polymyxins during the last few years is related to colistin. The polymyxins are active against selected gram-negative bacteria, including Acinetobacter species, Pseudomonas aeruginosa, Klebsiella species, and Enterobacter species. These drugs have been used extensively worldwide for decades for local use. However, parenteral use of these drugs was abandoned approximately 20 years ago in most countries, except for treatment of patients with cystic fibrosis, because of reports of common and serious nephrotoxicity and neurotoxicity. Recent studies of patients who received intravenous polymyxins for the treatment of serious P. aeruginosa and Acinetobacter baumannii infections of various types, including pneumonia, bacteremia, and urinary tract infections, have led to the conclusion that these antibiotics have acceptable effectiveness and considerably less toxicity than was reported in old studies.
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            Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections.

            Jian LI, Roger Nation, John D Turnidge … (2006)
            Increasing multidrug resistance in Gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, presents a critical problem. Limited therapeutic options have forced infectious disease clinicians and microbiologists to reappraise the clinical application of colistin, a polymyxin antibiotic discovered more than 50 years ago. We summarise recent progress in understanding the complex chemistry, pharmacokinetics, and pharmacodynamics of colistin, the interplay between these three aspects, and their effect on the clinical use of this important antibiotic. Recent clinical findings are reviewed, focusing on evaluation of efficacy, emerging resistance, potential toxicities, and combination therapy. In the battle against rapidly emerging bacterial resistance we can no longer rely entirely on the discovery of new antibiotics; we must also pursue rational approaches to the use of older antibiotics such as colistin.
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              Polymyxins revisited.

              John Quale, Larry D. Martin, Claudiu A Georgescu … (2008)
              The global emergence of multidrug-resistant gram-negative bacilli has spurred a renewed interest in polymyxins. Once discarded due to concerns regarding nephrotoxicity and neurotoxicity, polymyxins now hold an important role in the antibiotic armamentarium. However, more reliable information is needed to determine the optimal dosing of these agents. Also, unanswered questions regarding in vitro testing remain, including questions regarding the reliability of automated systems and the establishment of appropriate breakpoints for defining susceptibility. Most contemporary clinical studies examining the use of these agents have involved patients with infections due to multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains. It has been reassuring that polymyxin therapy for resistant bacteria has resulted in clinical responses and toxicity rates similar to those for carbapenem therapy for susceptible isolates. While most surveillance studies demonstrated high rates of susceptibility, several reports noted the emergence of polymyxin-resistant nosocomial pathogens. Polymyxins have assumed an important antibiotic niche for therapy for hospital-acquired infections; further studies defining the optimal use of these agents will likely extend the duration of their clinical usefulness.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Infect Dis Rep
                Journal ID (iso-abbrev): Infect Dis Rep
                Journal ID (publisher-id): IDR
                Title: Infectious Disease Reports
                Publisher: PAGEPress Publications, Pavia, Italy
                ISSN (Print): 2036-7430
                ISSN (Electronic): 2036-7449
                Publication date (Electronic): 23 September 2014
                Publication date Collection: 13 August 2014
                Volume: 6
                Issue: 3
                Electronic Location Identifier: 5413
                Affiliations
                [1 ]Intensive Care Medicine, King Saud Medical City , Riyadh
                [2 ]Division of Infectious Diseases, Prince Sultan Military Medical City , Riyadh, Saudi Arabia
                Author notes
                Intensive Care Medicine, King Saud Medical City, PO Box 331140, Post Code 11373, Shumaisy, Riyadh, Saudi Arabia. +96.656.688.1506. drasimrana@ 123456yahoo.com

                Contributions: MAR, conceived the idea of the study, had a leading role in patient management, data collection and manuscript preparation; BAER, literature review and manuscript revision; AFM, MAO, OER, manuscript revision; AHA, data collection and manuscript revision; SAM, literature review, data collection and manuscript revision; ASO, literature review, manuscript revision and re-drafting.

                Conflict of interests: the authors declare no potential conflict of interests.

                Article
                DOI: 10.4081/idr.2014.5413
                PMC ID: 4178267
                PubMed ID: 25276329
                SO-VID: ee7c496a-7dc9-462a-8000-187f2659da74
                Copyright © ©Copyright M.A. Rana et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 29 May 2014
                Date revision received : 08 July 2014
                Date accepted : 14 July 2014
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 26, Pages: 3
                Categories
                Subject: Case Report

                Keywords: multi drug resistant,gram negative bacteria,colistin,colistemethate sodium,acinetobacter baumannii,intrapleural infection
                Data availability:
                Keywords: multi drug resistant, gram negative bacteria, colistin, colistemethate sodium, acinetobacter baumannii, intrapleural infection

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