The impact of colistin minimum inhibitory concentration on clinical failure and mortality: insights from the OVERCOME trial
Issued Date
2026-01-01
Resource Type
ISSN
1198743X
eISSN
14690691
Scopus ID
2-s2.0-105042471241
Pubmed ID
42250757
Journal Title
Clinical Microbiology and Infection
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Microbiology and Infection (2026)
Suggested Citation
Pogue J.M., Rybak M.J., Abdul-Mutakabbir J.C., Stamper K., Marchaim D., Thamlikitkul V., Carmeli Y., Chiu C.H., Daikos G., Dhar S., Durante-Mangoni E., Gikas A., Kotanidou A., Paul M., Roilides E., Samarkos M., Sims M., Tancheva D., Tsiodras S., Kett D.H., Patel G., Calfee D.P., Leibovici L., Power L., Munoz-Price S., Susick L., Latack K., Chiou C., Divine G., Ghazyaran V., Narayanan N., Kaye K.S. The impact of colistin minimum inhibitory concentration on clinical failure and mortality: insights from the OVERCOME trial. Clinical Microbiology and Infection (2026). doi:10.1016/j.cmi.2026.05.046 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/117548
Title
The impact of colistin minimum inhibitory concentration on clinical failure and mortality: insights from the OVERCOME trial
Author(s)
Pogue J.M.
Rybak M.J.
Abdul-Mutakabbir J.C.
Stamper K.
Marchaim D.
Thamlikitkul V.
Carmeli Y.
Chiu C.H.
Daikos G.
Dhar S.
Durante-Mangoni E.
Gikas A.
Kotanidou A.
Paul M.
Roilides E.
Samarkos M.
Sims M.
Tancheva D.
Tsiodras S.
Kett D.H.
Patel G.
Calfee D.P.
Leibovici L.
Power L.
Munoz-Price S.
Susick L.
Latack K.
Chiou C.
Divine G.
Ghazyaran V.
Narayanan N.
Kaye K.S.
Rybak M.J.
Abdul-Mutakabbir J.C.
Stamper K.
Marchaim D.
Thamlikitkul V.
Carmeli Y.
Chiu C.H.
Daikos G.
Dhar S.
Durante-Mangoni E.
Gikas A.
Kotanidou A.
Paul M.
Roilides E.
Samarkos M.
Sims M.
Tancheva D.
Tsiodras S.
Kett D.H.
Patel G.
Calfee D.P.
Leibovici L.
Power L.
Munoz-Price S.
Susick L.
Latack K.
Chiou C.
Divine G.
Ghazyaran V.
Narayanan N.
Kaye K.S.
Author's Affiliation
University of Michigan, Ann Arbor
Weill Cornell Medicine
National and Kapodistrian University of Athens
Wayne State University
Wayne State University School of Medicine
Università degli Studi della Campania Luigi Vanvitelli
School of Medicine
National Institute of Allergy and Infectious Diseases (NIAID)
Robert Wood Johnson Medical School
Chang Gung University College of Medicine
Tel Aviv Sourasky Medical Center
Rabin Medical Center Israel
Siriraj Hospital
University of Michigan School of Public Health
Rambam Health Care Campus Israel
The Mount Sinai Hospital
Attikon University Hospital
Henry Ford Health System
Shamir Medical Center
Heraklion University Hospital
Skaggs School of Pharmacy & Pharmaceutical Sciences
Ernest Mario School of Pharmacy
Faculty of Health Sciences
UHealth Tower
Corewell Health William Beaumont University Hospital
Emergency Hospital Pirogov
Emerald Coast Infectious Diseases
Weill Cornell Medicine
National and Kapodistrian University of Athens
Wayne State University
Wayne State University School of Medicine
Università degli Studi della Campania Luigi Vanvitelli
School of Medicine
National Institute of Allergy and Infectious Diseases (NIAID)
Robert Wood Johnson Medical School
Chang Gung University College of Medicine
Tel Aviv Sourasky Medical Center
Rabin Medical Center Israel
Siriraj Hospital
University of Michigan School of Public Health
Rambam Health Care Campus Israel
The Mount Sinai Hospital
Attikon University Hospital
Henry Ford Health System
Shamir Medical Center
Heraklion University Hospital
Skaggs School of Pharmacy & Pharmaceutical Sciences
Ernest Mario School of Pharmacy
Faculty of Health Sciences
UHealth Tower
Corewell Health William Beaumont University Hospital
Emergency Hospital Pirogov
Emerald Coast Infectious Diseases
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives Colistin is an essential antibiotic against carbapenem-resistant Gram-negative bacilli. Pharmacokinetic and pharmacodynamic limitations impact its efficacy, and susceptibility breakpoints equivocate regarding interpretation of MIC values. This post hoc analysis of the OVERCOME trial investigated the association between colistin MIC and outcomes. Methods OVERCOME, a randomized, double-blind, placebo-controlled trial, compared colistin monotherapy with colistin plus meropenem for treatment of carbapenem-resistant Gram-negative bacilli pneumonia and/or bloodstream infections. Outcomes were compared between participants whose infections were caused by pathogens with colistin MIC values ≤1 mg/L and those with MIC values of 2 mg/L. Results Among 369 included participants, the mean age was 67.7 ± 15.9 years, 246 (67%) were in the intensive care unit, 251 (68%) had pneumonia, and 286 (78%) were infected with Acinetobacter baumannii . Overall, no association between an infecting pathogen with an MIC of 2 mg/L and either clinical failure (adjusted odds ratio [aOR]: 1.59 [95% CI: 0.72–3.52]) or 28-day mortality (aOR: 1.62 [95% CI: 0.85–3.09]) was demonstrated. Among participants receiving monotherapy, an infecting pathogen with an MIC of 2 mg/L was independently associated with both clinical failure (aOR: 3.59 [95% CI: 1.10–11.77]) and 28-day mortality (aOR: 3.22 [95% CI: 1.32–7.84]). Among participants receiving combination therapy, no association was demonstrated between MIC and outcomes. Conclusions When using colistin-based therapy for pathogens with an MIC of 2 mg/L, these findings support colistin and meropenem combination therapy over colistin monotherapy, particularly for pneumonia due to A. baumannii .