KOLİSTİN DİRENÇLİ ACINETOBACTER BAUMANNII TEDAVİSİNDE SIRA DIŞI BİR ANTİBİYOTİK KOMBİNASYON TEDAVİSİ: TRİMETOPRİM-SÜLFAMETOKSAZOL VE KOLİSTİN KOMBİNASYONU

Acinetobacter baumannii ventilatör ilişkili pnömoni, kan dolaşımı infeksiyonları, cerrahi alan infeksiyonları ve idrar yolu infeksiyonları gibi çeşitli infeksiyonlara yol açan önemli bir nozokomiyal patojen olarak kabul edilmektedir. A.baumannii izolatlarına karşı artan direnç endişe konusudur. Çoklu ilaç dirençli Gram negatif patojenlere karşı kolistin etkili bir ajandır. Ancak artan maruziyet kolistine direncin ortaya çıkmasına yol açarak bu patojene karşı tedavi seçeneklerini sınırlamıştır. Kolistinin tigesiklin, ampisilin-sulbaktam, rifampin ve karbapenem ile kombinasyonu bu suşların neden olduğu infeksiyonlarda diğer tedavi seçenekleridir. Çalışmamızda yoğun bakım ünitesinde takip edilen sadece trimetoprim- sülfametoksazole (SXT) duyarlı bir A.baumannii suşuna bağlı gelişen ventilatör ilişkili pnömoni olgusunda kullanılan kolistin ve SXT kombinasyon tedavisi bildirilmiştir. Çoklu antibiyotik dirençli A.baumannii infeksiyonlarında geleneksel olmayan antibiyotikler ile kolistin kombinasyonu umut verici alternatif tedavi olabilmektedir. Kolistin ve SXT tedavisi ile kür sağlanan bu olgu, başka seçeneğin olmadığı durumlarda Acinetobacter türlerine karşı etkili olmayan SXT'nin kolistin ile kombinasyonunun tedavide düşünülebileceğini vurgulamak için sunulmuştur

An Unusual Antibiotic Combination Therapy for Treatment of Colistin Resistant Acinetobacter baumannii: Trimethoprim-Sulfamethoxazole and Colistin Combination

An Unusual Antibiotic Combination Therapy for Treatment of Colistin Resistant Acinetobacter baumannii: Trimethoprim-Sulfamethoxazole and Colistin CombinationAcinetobacter baumannii is regarded as an important nosocomial pathogen causing various infections including ventilator-associated pneumonia, bloodstream infections, surgical site infections, and urinary tract infections. There is growing concern about increased resistance to Acinetobacter baumannii isolates. Colistin is an effective agent against multidrugresistant (MDR) gram-negative pathogens. However, increased exposure has led to emergence of colistin resistance, limiting the therapeutic options against this pathogen. Colistin, in combination with other agents such as tigecycline, ampicillinsulbactam, rifampin, and carbapenems are alternative treatment options for infections caused by these strains. In our study, combination therapy with colistin and trimethoprim-sulfamethoxazole (SXT) was used for ventilator-associated pneumonia due to A.baumannii only susceptible to SXT followed in intensive care unit. Combinations of colistin with non-traditional antibiotics might be promising alternatives for treatment of MDR strains of A.baumannii infections. This patient who was cured with colistin and SXT treatment was presented to emphasize that despite being usually ineffective against Acinetobacter spp., when no other option exists, SXT combined with colistin might be considered

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