Clinical and Microbiological Efficacy of Colistin Therapy Alone or in Combination as Treatment for Multidrug Resistant<i>Pseudomonas aeruginosa</i>Diabetic Foot Infections with or Without Osteomyelitis

Tascini, Carlo; Gemignani, G; Palumbo, Francesca; Leonildi, Alessandro; Tedeschi, Anna; Lambelet, Paola; Lucarini, Alessandra; Piaggesi, Alberto; Menichetti, Francesco

doi:10.1179/joc.2006.18.6.648

Cited by 40 publications

(12 citation statements)

References 10 publications

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“…38 Studies in adults have failed to show improved outcomes when combination therapy is used, but as these studies were observational, they may have been subject to confounding by indication. 43–46 Although the role of combination therapy remains uncertain, combination therapy may nonetheless prove to be beneficial. As the distribution of colistin to the lung parenchyma, bones and cerebrospinal fluid is relatively poor, the addition of a second agent may ensure more acceptable antibiotic concentrations in these tissues.…”

Section: Discussionmentioning

confidence: 99%

The Use of Intravenous Colistin Among Children in the United States

Tamma

Newland

Pannaraj

et al. 2013

Pediatric Infectious Disease Journal

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Background A rapid increase in multidrug-resistant Gram-negative infections has led to a reemergence of colistin use globally. Although it is well described among adults, colistin use and its associated toxicities in children are poorly understood. We report findings from the largest case series of pediatric colistin use to date. Methods We queried pediatric infectious diseases specialists from the Emerging Infections Network to identify members who had prescribed intravenous colistin within the past 7 years. We collected relevant demographic and clinical data. Bivariate analyses and multivariable logistic regression were performed. Results Two hundred twenty-nine pediatric infectious diseases specialists completed the survey (84% response); 22% had prescribed colistin to children. Among respondents, 92 cases of colistin use from 25 institutions were submitted. The most commonly targeted organisms were multidrug-resistant Pseudomonas (67.4%), multidrug-resistant Acinetobacter baumanii (11.9%), carbapenemase-producing Enterobacteriaceae (13.0%) and extended-spectrum β-lactamase producing Enterobacteriaceae (5.4%). Development of resistance to colistin was observed in 20.5% of patients. Additional antimicrobial therapy was administered to 84% of patients, and 22% of children experienced nephrotoxicity (not associated with dosage or interval of colistin prescribed). Renal function returned to baseline in all patients. Children aged ≥13 years had approximately 7 times the odds of developing nephrotoxicity than younger children, even after controlling for receipt of additional nephrotoxic agents (odds ratio 7.16; 95% confidence interval: 1.51–14.06; P = 0.013). Four children exhibited reversible neurotoxicity. Conclusions Most pediatric infectious diseases specialists have no experience prescribing colistin. Colistin use in children has been associated primarily with nephrotoxicity and, to a lesser extent, neurotoxicity, both of which are reversible. Emergence of resistance to colistin is concerning.

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Section: Discussionmentioning

confidence: 99%

The Use of Intravenous Colistin Among Children in the United States

Tamma

Newland

Pannaraj

et al. 2013

Pediatric Infectious Disease Journal

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“…Colistin, an older parenteral polymyxin E agent, has been used for treatment of resistant Acinetobacter, Klebsiella, and Pseudomonas bone infections. 52 Tigecycline can also be used for some Acinetobacter and Klebsiella infections but is not active against Pseudomonas.…”

Section: Enterococci and Vancomycin-resistant Enterococcimentioning

confidence: 99%

Systemic Antimicrobial Therapy in Osteomyelitis

Fraimow

2009

Seminars in Plastic Surgery

124

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Appropriately designed antibiotic regimens are critical to the management of all stages of osteomyelitis, although goals of therapy may vary in different stages of infection. The most important consideration for antibiotic selection is spectrum of action. Route of administration by intravenous or oral route is less important than drug levels that are achievable at the site of infection. Outpatient parenteral therapy and use of oral agents has simplified delivery of long-term treatment regimens. There are few high-quality studies that compare specific treatment regimens or durations of therapy, and recommendations for drugs and duration of antibiotic therapy are based on expert opinion, case series, and extrapolations from animal models. Intravenous beta-lactams are the treatment of choice for methicillin-susceptible Staphylococcus aureus, but there are also oral options available. Vancomycin has been the treatment of choice for methicillin-resistant Staphylococcus aureus osteomyelitis, but there are several newer parenteral and oral agents for treatment of methicillin-resistant Staphylococcus aureus including linezolid and daptomycin. Rifampin combined with other staphylococcal agents may increase cure rates, especially for device-associated infections. Oral fluoroquinolones and parenteral beta-lactam agents can be used for treatment of gram-negative osteomyelitis, but increasing resistance has complicated management of these infections.

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“…rates between treatments with colistin and colistin/antibiotic combinations was observed for MDR Gram-negative bacterial infections, [11][12][13][14][15] and nephrotoxicity was increased with the combination therapy. [12] Apart from colistin, several cationic antimicrobial polymers were also utilized as adjuvants to enhance antibacterial activity of antibiotics.…”

Section: Introductionmentioning

confidence: 98%

A Macromolecule Reversing Antibiotic Resistance Phenotype and Repurposing Drugs as Potent Antibiotics

et al. 2020

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In order to mitigate antibiotic resistance, a new strategy to increase antibiotic potency and reverse drug resistance is needed. Herein, the translocation mechanism of an antimicrobial guanidinium‐functionalized polycarbonate is leveraged in combination with traditional antibiotics to afford a potent treatment for drug‐resistant bacteria. Particularly, this polymer–antibiotic combination approach reverses rifampicin resistance phenotype in Acinetobacter baumannii demonstrating a 2.5 × 105‐fold reduction in minimum inhibitory concentration (MIC) and a 4096‐fold reduction in minimum bactericidal concentration (MBC). This approach also enables the repurposing of auranofin as an antibiotic against multidrug‐resistant (MDR) Gram‐negative bacteria with a 512‐fold MIC and 128‐fold MBC reduction, respectively. Finally, the in vivo efficacy of polymer–rifampicin combination is demonstrated in a MDR bacteremia mouse model. This combination approach lays foundational ground rules for a new class of antibiotic adjuvants capable of reversing drug resistance phenotype and repurposing drugs against MDR Gram‐negative bacteria.

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Clinical and Microbiological Efficacy of Colistin Therapy Alone or in Combination as Treatment for Multidrug ResistantPseudomonas aeruginosaDiabetic Foot Infections with or Without Osteomyelitis

Cited by 40 publications

References 10 publications

The Use of Intravenous Colistin Among Children in the United States

The Use of Intravenous Colistin Among Children in the United States

Systemic Antimicrobial Therapy in Osteomyelitis

A Macromolecule Reversing Antibiotic Resistance Phenotype and Repurposing Drugs as Potent Antibiotics

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