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Ventilator-associated pneumonia due to colistin susceptible-only microorganisms

¹ Critical Care Service, Profesor Alejandro Posadas Hospital, Haedo, ² Pulmonary and Critical Care Divisions, Hospital de Clínicas, Buenos Aires University, and ³ Critical Care Service, HIGA Eva Perón Hospital, San Martin, Buenos Aires, Argentina.

CORRESPONDENCE: C. M. Luna, Acevedo 1070, Banfield (1828), Buenos Aires, Argentina. Fax: 54 1142423066. E-mail: cymluna{at}fmed.uba.ar

Keywords: Antibiotic resistance, antibiotic treatment of pneumonia, bacterial infections, ventilator-associated pneumonia

Received: December 3, 2006
Accepted April 22, 2007

Acinetobacter spp. and Pseudomonas aeruginosa are common pathogens of ventilator-associated pneumonia (VAP). The presentation and outcome of VAP due to Acinetobacter spp. and P. aeruginosa susceptible to carbapenems (Carb-S; imipenem and/or meropenem) and to colistin only (Col-S) were compared in the present retrospective study in three intensive care units.

A total of 61 episodes of VAP caused by Acinetobacter spp. or P. aeruginosa were studied, of which 30 isolates were Carb-S and 31 were Col-S.

Demographics, worsening of renal function and mortality were not different. The univariate analysis showed that a later onset and a previous episode of VAP, prior antimicrobial therapy for >10 days and previous therapy with carbapenems during the present admission were more frequent in patients with Col-S strains. On multivariate analysis, prior antimicrobial therapy for >10 days and a previous episode of VAP remained significantly associated with Col-S VAP. Approximately 41% of the infections caused by Col-S isolates, but none of those due to Carb-S isolates, had received prior carbapenem therapy.

Colistin-susceptible ventilator-associated pneumonia episodes can be effectively treated using colistin without significant renal dysfunction. This susceptibility pattern could be suspected in patients with a previous ventilator-associated pneumonia episode or prior antibiotic therapy for >10 days preceding the present ventilator-associated pneumonia episode.

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