Sudden respiratory muscle paralysis and apnea in a patient infected with multidrug-resistant Pseudomonas aeruginosa treated with intravenous colistin

The mounting prevalence worldwide of infections due to multidrug-resistant Gram-negative bacilli has renewed interest in colistin, an antibiotic that was progressively abandoned during the 1970s due to significant renal and neurological toxicity.1 Respiratory failure with colistin use was reported in the years following its release; however, there are only two recent reports of colistin-induced respiratory failure, occurring on days 5 and 18 of treatment, respectively.2,3 We report a case of neurotoxicity manifesting as apnea and respiratory failure associated with intravenous colistimethate sodium (CMS).