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Ventilator-associated pneumonia with Col-S strains: a successful comeback of colistin!
C Mukhopadhyay1, S Krishna, K E Vandana
1Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India. chiranjay@yahoo.co.in
Abstract:
Emergence of multi and pan-drug resistant Gram-negative bacteria causing nosocomial infections in intensive care settings has become a challenge for clinicians. The mortality rate of ventilator-associated pneumonia (VAP) is known to increase when the initial microbiological diagnosis and antimicrobial therapy are inappropriate. We present a case of a 18-year-old man, who after being admitted following an accident, had developed VAP due to multi-drug resistant Pseudomonas aeruginosa and Acinetobacter spp. and had a downhill clinical course despite broad-spectrum antibiotic treatment. The strains were found to be Col-S, as the susceptibility was tested. Colistin was instituted, with remarkable recovery. It is imperative to diagnose VAP with multi-drug resistant strains as early as possible; colistin, the 'last resort' antibiotic, if instituted with proper monitoring at the right time, can be life saving.
Insights
Multi-drug resistant bacteria in intensive care units pose a significant threat. Early diagnosis and timely use of colistin, a last-resort antibiotic, can be life-saving for ventilator-associated pneumonia (VAP).
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Nosocomial infections caused by multidrug-resistant (MDR) Gram-negative bacteria present a major clinical challenge, particularly in intensive care settings.
- Ventilator-associated pneumonia (VAP) has increased mortality rates linked to inappropriate initial antimicrobial therapy.
- The emergence of pan-drug resistant organisms necessitates novel therapeutic strategies.
Observation:
- A case study of an 18-year-old male admitted after an accident developed VAP.
- The patient's VAP was caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter spp.
- Despite broad-spectrum antibiotics, the patient experienced a downhill clinical course.
Findings:
- Microbiological testing revealed the isolated Gram-negative strains were susceptible to colistin (Col-S).
- Administration of colistin resulted in a remarkable clinical recovery for the patient.
- This highlights the potential efficacy of colistin in treating VAP caused by MDR Gram-negative bacteria.
Implications:
- Early and accurate diagnosis of VAP caused by MDR strains is crucial for effective treatment.
- Colistin, considered a 'last resort' antibiotic, can be life-saving when administered promptly and monitored appropriately.
- This case underscores the importance of colistin stewardship and its role in managing challenging Gram-negative infections.
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