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Background   Acinetobacter 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.    Methods  Clinical 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.    Results  Four 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.    Discussion  An 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.    Conclusions  Our 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.    Electronic supplementary material  The online version of this article (doi:10.1186/s12879-015-1133-3) contains supplementary material, which is available to authorized users.

bmc infectious diseases

The role of vancomycin in addition with colistin and meropenem against colistin-sensitive multidrug resistant Acinetobacter baumannii causing severe infections in a Paediatric Intensive Care Unit