Case Report: Colistin Use in the Treatment of Multidrug Resistant Pseudomonas aeruginosa

Twenty years old male patient who had hod brain tumor and hydrocephalus was referred to our clinic because of ventriculo-peritoneal shunt (VPS) infection. Klebsiella pneumoniae (ESBL negative) and Staphylococcus aureus (MSSA) were isolated from cerebrospinal fluid (CSF) and blood culture respectively, cefepime and amikacin were initiated. Multidrug resistant Pseudomonas aeruginosa was isolated from CSF during antibiotic therapy. The microorganism was resistant to third and fourth generation antipseudomonal cephalosporins, antipseudomonal penicillin + beta-lactamase inhibitor combination, quinolons, carbapenems, aminoglycosides by E-test and intravenous colistin was started (later intrathecal too). During this treatment multidrug resistant P. aeruginosa continued to be isolated. Therefore we removed the VPS and continued colistin therapy. CSF cultures were sterile in the controls. There was no side effects and the drug was good tolerated. The therapy cost was 33.6 Deutche Mark (DM) per day. Colistin, which is not marketed in our country, can be an alternative in the treatment of gram-negative microorganisms, which are resistant to other antimicrobials