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Antimicrobial Agents and Chemotherapy, June 2002, p. 1946-1952, Vol. 46, No. 6
0066-4804/02/$04.00+0     DOI: 10.1128/AAC.46.6.1946-1952.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Efficacy of Colistin versus ß-Lactams, Aminoglycosides, and Rifampin as Monotherapy in a Mouse Model of Pneumonia Caused by Multiresistant Acinetobacter baumannii

A. Montero,^1* J. Ariza,¹ X. Corbella,¹ A. Doménech,¹ C. Cabellos,¹ J. Ayats,² F. Tubau,² C. Ardanuy,^2, and F. Gudiol¹

Laboratory of Experimental Infection, Infectious Disease Service,¹ Microbiology Department, Hospital de Bellvitge, University of Barcelona, 08907 L'Hospitalet de Llobregat, Barcelona, Spain²

Received 3 December 2001/ Returned for modification 2 January 2002/ Accepted 7 March 2002

The treatment of life-threatening infections due to carbapenem-resistant Acinetobacter baumannii has become a serious challenge for physicians worldwide. Often, only colistin shows in general good in vitro activity against these carbapenem-resistant strains, but its antibacterial efficacy in comparison with the antibiotics most used in clinical practice is not well known. We studied the efficacy of colistin versus those of imipenem, sulbactam, tobramycin, and rifampin in an experimental pneumonia model with immunocompetent mice. We used three strains of A. baumannii corresponding to the main clones (A, D, and E) involved in the outbreaks of our hospital, with different grades of resistance to imipenem (imipenem MICs of 1, 8, and 512 µg/ml, respectively) and to the other antibiotics. The MIC of colistin was 0.5 µg/ml for the three strains. Reduction of log₁₀ CFU/g in lung bacterial counts, clearance of bacteremia, and survival versus results with controls were used as parameters of efficacy. Imipenem and sulbactam (lung counts: -5.38 and -4.64 log₁₀ CFU/ml) showed the highest level of bactericidal efficacy in infections by susceptible and even intermediate strains. Tobramycin and rifampin (-4.16 and -5.15 log₁₀ CFU/ml) provided good results against intermediate or moderately resistant strains, in agreement with killing curves and pharmacodynamics. On the contrary, colistin showed the weakest antibacterial effect among the antibiotics tested, both in killing curves and in the in vivo model (-2.39 log₁₀ CFU/ml; P < 0.05). We conclude that colistin did not appear as a good option for treatment of patients with pneumonia due to carbapenem-resistant A. baumannii strains. Other alternatives, including combinations with rifampin, may offer better therapeutic profiles and thus should be studied.

Present address: Hospital Universitari Joan XXIII, 43007 Tarragona, Spain.

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