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. 2015 Sep 30;15:393.
doi: 10.1186/s12879-015-1133-3.

The Role of Vancomycin in Addition With Colistin and Meropenem Against Colistin-Sensitive Multidrug Resistant Acinetobacter Baumannii Causing Severe Infections in a Paediatric Intensive Care Unit

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Free PMC article

The Role of Vancomycin in Addition With Colistin and Meropenem Against Colistin-Sensitive Multidrug Resistant Acinetobacter Baumannii Causing Severe Infections in a Paediatric Intensive Care Unit

Giancarlo Ceccarelli et al. BMC Infect Dis. .
Free PMC article

Abstract

Background: Acinetobacter baumannii has been associated with high morbidity and mortality rates, even in pediatric patients. Therapeutic options are limited, especially when the strain is multidrug resistant.

Methods: Clinical and microbiological analyses of 4 cases of systemic infections caused by multi drug resistant A. baumannii treated with colistin/vancomycin combination at a Pediatric Intensive Care Unit were performed in order to explore the potential synergistic activity of colistin plus vancomycin. All the patients were treated with colistin, meropenem and vancomycin.

Results: Four severe infections due to MDR A. baumannii were observed. All patients treated with colistin/vancomycin combination had a positive outcome with no infection relapses. Most importantly, no significant adverse events related to the simultaneous administration of COL plus VAN were observed. In our in-vitro experiments, the synergistic effect of the combination COL plus VAN showed an early bactericidal activity even at VAN concentration of 16 mg/L, which reflects the serum trough concentrations obtained in patients.

Discussion: An antimicrobial strategy based on the activity of colistin plus vancomycin was in-vitro and in-vivo effective in life-threatening infections caused by multidrug-resistant A. baumannii in a Pediatric Intensive Care Unit, in the absence of adverse effects. Colistin plus vancomycin were highly synergic and bactericidal against carbapenem-resistant, colistin sensitive A. baumannii whereas the addition of meropenem did not enhance the in-vitro activity of colistin plus vancomycin.

Conclusions: Our results confirm existing data on the potential synergistic activity of a therapeutic strategy including colistin plus vancomycin and provide important new clinical information for its potential use as a therapeutic option against MDR A. baumannii infections, especially in the pediatric population.

Figures

Fig. 1
Fig. 1
Clinical and therapeutic features of case-index MDR A. baumannii bacteremia. Procalcitonin levels increased up to 7 mg/L under treatment with COL + RIF, which was expression of treatment failure. Rather, it started to decrease under COL + VAN + MEM therapy and reached the normal value after 15 days of such therapy. The decreasing levels of procalcitonin following therapy with COL + VAN + MEM was expression of treatment success. COL: Colistin, VAN: Vancomycin, RIF: Rifampin, MEM: Meropenem
Fig. 2
Fig. 2
Time–kill studies for colistin (COL), meropenem (MEM) and vancomycin (VAN), alone and in combination, against MDR A. baumannii. a The bactericidal activity of COL + VAN is represented. Values in bracket represent the actual concentration (mg/L). b The bactericidal activity of COL + MEM is represented. Values in bracket represent the actual concentration (mg/L). c The bactericidal activity of COL + MEM + VAN is represented. The actual concentrations of the triple combinations are: 0.5 × MIC COL (0.5 mg/L) COL + 0.25 × MIC VAN (32 mg/L) + 0.5 × MIC MEM (64 mg/L) and 0.5 × MIC COL (0.5 mg/L) COL + 0.125 × MIC VAN (16 mg/L) + 0.5 × MIC MEM (64 mg/L). The dashed horizontal line represents a reduction of 3 log10 cfu/mL compared with the initial bacterial count. GC, growth control

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