Cure of multidrug-resistant (MDR) Acinetobacter baumannii bacteraemia with continuous intravenous infusion of colistin

Abstract number: 1135_78

Kasiakou S., Michalopoulos A., Rosmarakis E., Vergidis P., Falagas M.

Background:  

Although intermittent intravenous bolus dosing of antimicrobial agents is the standard way of administration of antibiotics in clinical practice, the last few years, there is renewed interest among clinicians and researchers in examining the benefits of continuous mode of treatment. Methods: Description of a patient with multidrug-resistant Acinetobacter baumannii bacteraemia who was successfully managed with continuous intravenous infusion of colistin.

Results:  

A 41-year-old white man was admitted to the ICU of our hospital because of sudden cervico-occipital headache accompanied by vomiting. A CT of the brain revealed extensive intraventricular haemorrhage originating from the basal ganglia. During his long-standing hospitalization to our hospital several events of clinical significance occurred. On day 84 of his hospitalization, the patient developed pneumonia due to Staphylococcus aureus and Pseudomonas aeruginosa strains. He was managed with intravenous antimicrobial agents including vancomycin, gentamicin, and piperacillin/tazobactam, which led to clinical improvement. However, on day 96, the above-mentioned isolates grew again from cultures of bronchial secretions specimens. Gentamicin was discontinued, and intravenous ciprofloxacin and rifampin were started. On day 117, the patient developed an extensive maculopapular rash on the trunk and the extremities. In addition, ocular and perioral swelling was observed. All antimicrobial agents were discontinued. On day 119, he developed bacteraemia due to Klebsiella pneumoniae strain. Intravenous gentamicin was started but it was discontinued one day later due to the flare up of the rash. Finally, on day 127, a blood specimen culture grew a MDR Acinetobacter baumannii strain, sensitive only to colistin. A continuous intravenous infusion regimen with colistin 2,000,000 units per 24 hours was initiated. The clinical condition of the patient gradually improved, and the rash gradually diminished.

Conclusion:  

Continuous intravenous administration of colistin may be associated with fewer hypersensitivity (adverse) reactions and may be as effective as the traditional intermittent way of infusion.