• Giancarlo Ceccarelli, Alessandra Oliva, Gabriella d'Ettorre, Alessandra D'Abramo, Elena Caresta, Caterina Silvia Barbara, Maria Teresa Mascellino, Paola Papoff, Corrado Moretti, Vincenzo Vullo, Paolo Visca, and Mario Venditti.
• Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy. giancarlo.ceccarelli@uniroma1.it.
• Bmc Infect Dis. 2015 Sep 30; 15: 393.

BackgroundAcinetobacter baumannii has been associated with high morbidity and mortality rates, even in pediatric patients. Therapeutic options are limited, especially when the strain is multidrug resistant.MethodsClinical and microbiological analyses of 4 cases of systemic infections caused by multi drug resistant A. baumannii treated with colistin/vancomycin combination at a Pediatric Intensive Care Unit were performed in order to explore the potential synergistic activity of colistin plus vancomycin. All the patients were treated with colistin, meropenem and vancomycin.ResultsFour severe infections due to MDR A. baumannii were observed. All patients treated with colistin/vancomycin combination had a positive outcome with no infection relapses. Most importantly, no significant adverse events related to the simultaneous administration of COL plus VAN were observed. In our in-vitro experiments, the synergistic effect of the combination COL plus VAN showed an early bactericidal activity even at VAN concentration of 16 mg/L, which reflects the serum trough concentrations obtained in patients.DiscussionAn antimicrobial strategy based on the activity of colistin plus vancomycin was in-vitro and in-vivo effective in life-threatening infections caused by multidrug-resistant A. baumannii in a Pediatric Intensive Care Unit, in the absence of adverse effects. Colistin plus vancomycin were highly synergic and bactericidal against carbapenem-resistant, colistin sensitive A. baumannii whereas the addition of meropenem did not enhance the in-vitro activity of colistin plus vancomycin.ConclusionsOur results confirm existing data on the potential synergistic activity of a therapeutic strategy including colistin plus vancomycin and provide important new clinical information for its potential use as a therapeutic option against MDR A. baumannii infections, especially in the pediatric population.

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