Saturday, November 11, 2006

Updating the October case study's search results

I just reviewed the search retrieval in PubMed today for the case, and saw that there are a few new citations that may be of interest for updating the case. I've included a few notes below considering the relevance of each of these potential additions to our literature summary on this clinical question.

New reference #1: Falagas ME, Kasiakou SK, Kofteridis DP, Roditakis G, Samonis G. Effectiveness and nephrotoxicity of intravenous colistin for treatment of patients with infections due to polymyxin-only-susceptible (POS) gram-negative bacteria. Eur J Clin Microbiol Infect Dis. 2006 Sep;25(9):596-9. (PubMed record)
The first author in this study was involved in two of the review articles represented in the October case and one of the studies; this new article is a prospective case series including 27 patients with resistant Gram-negative infection treated with IV colistin. The authors indicate that the infection was pneumonia in 9 patients, who received inhaled colistin in addition to IV drug. The authors note "[i]n-hospital mortality and clinical response were 15% and 85%" and observed nephrotoxicity in 2 patients during the study. This article would be a good addition to the literature summarized in the October case for its inclusion of prospective primary data on efficacy and adverse effects of colistin in a patient population directly relevant to the patient situation we considered in the case.

New reference #2: Saballs M, Pujol M, Tubau F, Pena C, Montero A, Dominguez MA, Gudiol F, Ariza J. Rifampicin/imipenem combination in the treatment of carbapenem-resistant Acinetobacter baumannii infections. J Antimicrob Chemother. 2006 Sep;58(3):697-700. (PubMed record)
This is a small prospective study of 10 patients with Acinetobacter infection, examining rifampicin/imipenem as a possible alternative to colistin, finding that this antibiotic combination was not effective in treating resistant Acinetobacter infections (somewhat relevant, in ruling out an alternative therapeutic strategy) .

New reference #3: Linden PK, Paterson DL. Parenteral and inhaled colistin for treatment of ventilator-associated pneumonia. Clin Infect Dis. 2006 Sep 1;43 Suppl 2:S89-94. (PubMed record).
This is a new review article that discusses that efficacy of colistin for treating VAP, synthesizing 5 studies on the topic (including studies that examined inhaled rather than IV administration of the agent) and noting the incidence of colistin-induced nephrotoxicity ranging from 8-36%. This current review would likely serve as an update and replacement to the Jain and Danziger review covered in the October case.

These new references also point out that this is a developing topic; ongoing surveillance of the literature would be a useful proactive step for the librarian in this case, aiding the team with understanding the evidence as the literature evolves and maintaining clinical practices in line with the most current research data.

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