Safety and effectiveness of colistin compared with tobramycin for multi-drug resistant <it>Acinetobacter baumannii </it>infections

<p>Abstract</p> <p>Background</p> <p>Nosocomial infections due to multi-drug resistant <it>Acinetobacter baumannii </it>are often treated with colistin, but there are few data comparing its safety and efficacy with other antimicrobials.</p> <p>Methods</p> <p>A retrospective cohort study of patients treated with colistin or tobramycin for <it>A. baumannii </it>infections in intensive care units (ICUs) at Groote Schuur hospital. Colistin was used for <it>A. baumannii </it>isolates which were resistant to all other available antimicrobials. In the tobramycin group, 53% of the isolates were only susceptible to tobramycin and colistin. We assessed ICU mortality, nephrotoxicity and time to the first negative culture.</p> <p>Results</p> <p>32 patients, with similar admission APACHE scores and serum creatinine, were treated with each antimicrobial. There were no significant differences between the colistin and tobramycin groups in ICU mortality (p = 0.54), nephrotoxicity (p = 0.67), change in creatinine from baseline to highest subsequent value (p = 0.11) and time to microbiological clearance (p = 0.75). The hazard ratio for total in-hospital survival in patients treated with colistin compared to tobramycin was 0.43 (95% CI 0.19 to 0.99).</p> <p>Conclusion</p> <p>Our study suggests that colistin and tobramycin have similar risks of nephrotoxicity and are equally efficacious. Colistin is an acceptable antibiotic for the treatment of <it>A. baumanii </it>infections when the organism is resistant to other available antimicrobials.</p>

Abstract licence: CC BY-NC-ND

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