Clinical and Microbiological Efficacy of Colistin Therapy in Combination With Rifampin and Imipenem in Multidrug-Resistant Pseudomonas aeruginosa Diabetic Foot Infection With Osteomyelitis

Abstract

The evaluation of the safety and effectiveness of colistin in association with rifampin and imipenem in 1 diabetic patient with severe diabetic foot infection (DFI) due to multidrug-resistant (MDR) Pseudomonas aeruginosa, complicated by osteomyelitis, is presented in this “Case Report”. The patient received colistin after other ineffective antimicrobial treatment when an MDR P aeruginosa strain was isolated by cultural examination, together with a multidisciplinary care approach including surgical debridement and adequate offloading. The efficacy of combination colistin plus rifampin plus imipenem was observed with a checkerboard method and bactericidal activity of the serum. The patient received colistin combination therapy for 6 weeks with cure of the infection and without renal toxicity. These data suggest that colistin, in combination with rifampin and imipenem, is safe and effective, in promoting healing in DFI due to MDR P aeruginosa and suggest the need for controlled clinical studies.

Keywords

colistin diabetic foot rifampin imipenem P aeruginosa synergistic activity bactericidal activity osteomyelitis

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References

Ulbrecht JS , Cavanagh PR , Caputo GM. Foot problems in diabetes: an overview. Clin Infect Dis 2004;39: S73-S82.

Apelqvist J , Larsson J.

What is the most effective way to reduce incidence of amputation in the diabetic foot?

Diabetes Metab Res Rev 2000;16(Suppl 1): S75-S83.

Lipsky BA. Medical treatment of diabetic foot infections . Clin Infect Dis 2004;39: S104-S114.

Brown JM , Dorman DC , Roy LP. Acute renal failure due to overdosage of colistin. Med J Aust 1970;2: 923-924.

Falagas ME , Kasiakou SK. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis 2005;40: 1333-1341.

Clinical and Laboratory Standard Institute (formerly National Committee for Clinical Laboratory Standards) . Methodology for the serum bactericidal test. Document M-21A. Villanova (PA): Clinical and Laboratory Standard Institute; 1999.

Marques MB , Brookings ES , Moser SA , Sonke PB , Waites KB. Comparative in vitro antimicrobial susceptibilities of nosocomial isolates of Acinetobacter baumannii and synergistic activities of nine antimicrobial combinations. Antimicrob Agents Chemother 1997;41: 881-885.

Tascini C , Tagliaferri E , Iapoce R , Leonildi A , Menichetti F. Caspofungin in combination with itraconazole and amphotericin B for the treatment of invasive Aspergillosis in humans, with a method to test ex vivo synergism. Clin Microbiol Infect 2003;9: 901-902.

Tascini C , Gemignani G , Leonildi A , Menichetti F. Ex vivo synergism: a method for optimizing antimicrobial combinations for difficult-to-treat enterococcal endocarditis. J Chemother 2003; 15: 613-615.

10.

Paterson D , Cornaglia G , Mazzariol A , Lauretti L , Rossolini GM , Fontana R. Hospital outbreak of carbapenem-resistant Pseudomonas aeruginosa producing VIM-1, a novel transferable metallo-beta-lactamase. Clin Infect Dis 2000;31: 1119-1125.

11.

Tascini C , Gemignani G , Ferranti S , Tagliaferri E , Leonildi A , Lucarini A , et al. Microbiological activity and clinical efficacy of a colistin and rifampin combination in multidrug-resistant Pseudomonas aeruginosa infections. J Chemother 2004:16; 282-287.

12.

Tascini C , Ferranti S , Messina F , Menichetti F. In vitro and in vivo synergistic activity of colistin, rifampin and amikacin against a multi resistant Pseudomonas aeruginosa isolate. Clin Microbiol Infect 2000;6: 690-691.

13.

Landman D , Bratu S , Alam M , Quale J. Citywide emergence of Pseudomonas aeruginosa strains with reduced susceptibility to polymyxin B. J Antimicrob Chemother 2005;55: 954-957.

14.

Petrosillo N , Chinello P , Proietti MF , Cecchini L , Masala M , Franchi C , et al. Combined colistin and rifampin therapy for carbapenem-resistant Acinetobacter baumannii infections: clinical outcome and adverse events. Clin Microbiol Infect 2005; 11: 682-683.