Rifampicin combination therapies for colistin-resistant Acinetobacter spp. in an ICU

Abstract

Background: There is not a defined therapy for colistin-resistant acinetobacter infections. We aimed to present and discuss the results of ten intensive care unit (ICU) patients who had blood stream infections (BSIs) with colistin-resistant Acinetobacter spp. either pan-resistant (6 patients) or only tigecycline susceptible (4 patients) and who were treated with rifampicin combination regimens.

Methods: Patients who were reported to have BSIs with colistin-resistant Acinetobacter spp. and treated with rifampicin combination regimens were traced from ICU records between years 2014 and 2016, retrospectively. Their demographic data, antimicrobial use, length of ICU stay, SOFA scores, procalcitonin (PCT) levels and ICU outcomes were recorded.

Results: There were a total of 10 patients all of whom had history of colistin use. When blood cultures grew colistin-resistant Acinetobacter spp. rifampicin was added to all patients’ existing antimicrobials as salvage therapy. Eight patients improved to ICU discharge. Two patients with higher initial and follow-up SOFA scores were lost.

Conclusions: The treatment of colistin-resistant acinetobacter infections is an unsolved problem in ICUs.  When the importance of early accurate antibiotic choice is taken into account in critical patients, adding rifampicin to combination may have some favorable outcomes.