Ventilator associated Pneumonia due to Multi Drug Resistant, Colistin-S Acinetobacter baumannii: Successful Revival of Colistin, A Forgotten Drug
Ventilator associated pneumonia (VAP) is one of the most dreadful complications that occurs in critical care setting and is associated with significant morbidity and mortality, especially when the episode of pneumonia is due to a multi drug resistant (MDR) pathogen. Due to its varied clinical presentations, and the involvement of MDR pathogens, disease poses a serious diagnostic and therapeutic challenge for clinicians, left with limited options. Such resistant strains have disseminated worldwide and often remain susceptible only to agents such as, tigecycline and polymyxins which are usually considered as treatment of ‘last-resort’. The growing epidemic of infections in the intensive care units caused by such MDR strains has led clinicians to reconsider prescribing polymyxin antimicrobials [polymyxin B and polymyxin E (colistin)], that were removed from use in past because of the associated neurotoxicity and nephrotoxicity. Colistin, a polymyxin antibiotic appears as an appropriate therapeutic alternative. The available data on epidemiological and clinical characteristics of VAP, due to GNB susceptible only to colistin (col-S) is limited. We here report a case of ventilator associated pneumonia caused by a multi drug resistant, but colistin-S strain of Acinetobacter baumannii, where the combined use of aerosolized and intravenous colistin led to the positive patient outcome.