Colistin is Effective in the Treatment of Multidrug-Resistant Pseudomonas aeruginosa Infections in Cancer Patients.
Antimicrob Agents Chemother. 2007 Mar 26
The University of Texas M. D. Anderson Cancer Center, Department of Infectious Diseases, Houston, Texas, and Staten Island University Hospital, Staten Island, New York.
Background: The increasing incidence of infections caused by multidrug-resistant Pseudomonas aeruginosa is a worldwide health problem. Because no new anti-pseudomonal agents are expected to be available in the near future, we evaluated the safety and efficacy of colistin, an old drug with bactericidal activity against this organism.
Methods: We collected clinical and demographic data on 95 cancer patients diagnosed with multidrug-resistant P. aeruginosa between January 2001 and January 2004 and treated with either colistin (colistin group) or at least one active anti-pseudomonal agent (a beta-lactam antibiotic or quinolone) (control group). We compared both groups.
Results: Thirty-one patients had been treated with colistin and 64 had been treated with an anti-pseudomonal non-colistin-containing regimen. Compared with the control group, patients in the colistin group had lower median age (52 vs 62 years; P = 0.012), but more likely to have had nosocomial infections (87% vs 64%; P = 0.02). Twenty-five patients (81%) in the colistin group and 40 patients (63%) in the control group had an APACHE II score of >15 (P = 0.074). Overall clinical response rate was 52% in the colistin group versus 31% in the non-colistin group (P = 0.055). Multiple logistic regression analysis showed that those patients treated with colistin were 2.9 times (95% CI: 1.1 to 7.6) more likely to experience a clinical response to therapy than were those in the control group (P = 0.026).
Conclusions: Colistin therapy was at least as effective and as safe as beta-lactam antibiotics and quinolones in the treatment of multidrug-resistant P. aeruginosa infections and, hence, may be a useful or preferred alternative therapy for this infection in cancer patients.
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