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INFECTIOUS DISEASES

Polymyxin B and Doxycycline Use in Patients with Multidrug-Resistant Acinetobacter baumannii Infections in the Intensive Care Unit

Clinical Assistant Professor, Internal Medicine, Department of Clinical and Administrative Sciences, Mercer University College of Pharmacy and Health Sciences, Atlanta, GA

Nadine G Rouphael, MD

Fellow, Infectious Diseases, Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta

Jane B Wells, PharmD

Clinical Pharmacist Specialist, Department of Pharmacy and Drug Information, Infectious Diseases, Grady Health System, Atlanta

Mark D King, MD

Assistant Professor of Medicine, Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University; Department of Hospital Epidemiology, Grady Memorial Hospital

Henry M Blumberg, MD

Professor of Medicine, Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University; Department of Hospital Epidemiology, Grady Memorial Hospital

Reprints: Dr. Holloway, Department of Clinical and Administrative Sciences, Mercer University College of Pharmacy and Health Sciences, 3001 Mercer University Dr., Atlanta, GA 30341-4155, fax 678/547-6384, holloway_kp{at}mercer.edu

BACKGROUND: Multidrug-resistant Acinetobacter baumannii (MDR-Ab) has emerged as an increasingly problematic cause of hospital-acquired infections in the intensive care unit (ICU). MDR-Ab is resistant to most standard antimicrobials but often retains susceptibility to polymyxin B and doxycycline.

OBJECTIVE: To evaluate the efficacy and toxicity of polymyxin B and doxycycline in the treatment of MDR-Ab infections.

METHODS: A retrospective chart review was conducted between March 2002 and May 2005 in patients who received doxycycline or polymyxin B for treatment of MDR-Ab infections in ICUs within Grady Memorial Hospital, Atlanta, GA.

RESULTS: Thirty-seven patients with MDR-Ab infections were treated with polymyxin B or doxycycline. Median age was 41 years and median ICU length of stay was 18 days prior to acquisition of MDR-Ab. Clinical cure was observed in 22 of 29 (76%) evaluable patients treated with polymyxin B and 2 of 4 (50%) patients treated with doxycycline. In patients with follow-up cultures, microbiological cure was observed in 17 of 21 (81%) patients treated with polymyxin B and 2 of 3 (67%) patients treated with doxycycline. Nephrotoxicity developed in 21% (7 of 33) of patients who received polymyxin B. Neurotoxicity was observed in 2 (6%) patients who received polymyxin B. No adverse reactions were observed with doxycycline. Overall, crude mortality was 27% (9 of 33) and 75% (3 of 4) among those who received polymyxin B and doxycycline, respectively. Three (9%) deaths were attributed to polymyxin B treatment failure, and no deaths were attributed to doxycycline treatment failure.

CONCLUSIONS: Polymyxin B was effectively used to treat a substantial proportion of critically ill patients with MDR-Ab infection and was associated with a similar rate of nephrotoxicity as previously reported. Doxycycline monotherapy was used in a limited number of patients for the treatment of MDR-Ab; further evaluation of its efficacy in larger numbers of patients is warranted.

Key Words: Acinetobacter baumannii, colistin, doxycycline, polymyxin B

Published Online, October 3, 2006. www.theannals.com, DOI 10.1345/aph.1H353

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