Local use of colistimethate sodium as antimicrobial dressing agent in multidrug-resistant gram-negative bacteria-colonised pressure injuries in spinal cord injury patients: A case series

Despite advancements in dressing materials and techniques, the management of pressure injuries (PIs) remains a challenging problem for clinicians across the world. The failure to heal in PIs is multifactorial such as nutritional status of patients, bacterial load, site of ulcer, risk of contamination and presence of comorbidities. Multidrug-resistant (MDR) Gram-negative bacterial (GNB) infections are frequent occurrence in hospitalised patients with PI. The limited chemotherapeutic options available for treating MDR strains of GNB have forced the reintroduction of the cationic cyclic peptide, polymyxin E (colistin). We report a case series of seven patients of traumatic spinal cord injury with PIs and poor healing due to MDR GNB sensitive only to colistin. In view of the worsening condition of the PIs and financial constraints, it was decided to start colistin therapy locally by colistimethate sodium. All patients responded well to the treatment and got clinically better. In our study, we used the Pressure Ulcer Scale for Healing score, Functional Independence Measure and World Health Organization Quality of Life Brief Version score to measure the outcome. We found this novel dressing a very promising and cost-effective treatment option in achieving infection-free healing, especially against MDR strains of bacteria.