Prime

Type your tag names separated by a space and hit enter

High-dose, extended-interval colistin administration in critically ill patients: is this the right dosing strategy? A preliminary study.

Abstract

BACKGROUND

Gram-negative bacteria susceptible only to colistin (COS) are emerging causes of severe nosocomial infections, reviving interest in the use of colistin. However, consensus on the most effective way to administer colistin has not yet been reached.

METHODS

All patients who had sepsis due to COS gram-negative bacteria or minimally susceptible gram-negative bacteria and received intravenous colistimethate sodium (CMS) were prospectively enrolled. The CMS dosing schedule was based on a loading dose of 9 MU and a 9-MU twice-daily fractioned maintenance dose, titrated on renal function. For each CMS course, clinical cure, bacteriological clearance, daily serum creatinine clearance, and estimated creatinine clearance were recorded.

RESULTS

Twenty-eight infectious episodes due to Acinetobacter baumannii (46.4%), Klebsiella pneumoniae (46.4%), and Pseudomonas aeruginosa (7.2%) were analyzed. The main types of infection were bloodstream infection (64.3%) and ventilator-associated pneumonia (35.7%). Clinical cure was observed in 23 cases (82.1%). Acute kidney injury developed during 5 treatment courses (17.8%), did not require renal replacement therapy, and subsided within 10 days from CMS discontinuation. No correlation was found between variation in serum creatinine level (from baseline to peak) and daily and cumulative doses of CMS, and between variation in serum creatinine level (from baseline to peak) and duration of CMS treatment.

CONCLUSIONS

Our study shows that in severe infections due to COS gram-negative bacteria, the high-dose, extended-interval CMS regimen has a high efficacy, without significant renal toxicity.

Links

  • PMC Free PDF
  • PMC Free Full Text
  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Anesthesia and Intensive Care Unit, Department of Emergeny and Organ Transplantion, University of Bari, Piazza G. Cesare 11, 70124 Bari, Italy. dalfino@tiscali.it

    , , , , , , ,

    Source

    MeSH

    Aged
    Aged, 80 and over
    Anti-Bacterial Agents
    Cohort Studies
    Colistin
    Critical Illness
    Cross Infection
    Female
    Gram-Negative Bacterial Infections
    Humans
    Kidney Diseases
    Male
    Middle Aged
    Prospective Studies
    Sepsis
    Treatment Outcome

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22423120

    Citation

    TY - JOUR T1 - High-dose, extended-interval colistin administration in critically ill patients: is this the right dosing strategy? A preliminary study. AU - Dalfino,Lidia, AU - Puntillo,Filomena, AU - Mosca,Adriana, AU - Monno,Rosa, AU - Spada,Maria Luigia, AU - Coppolecchia,Sara, AU - Miragliotta,Giuseppe, AU - Bruno,Francesco, AU - Brienza,Nicola, Y1 - 2012/03/15/ PY - 2012/3/17/entrez PY - 2012/3/17/pubmed PY - 2012/9/13/medline SP - 1720 EP - 6 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 54 IS - 12 N2 - BACKGROUND: Gram-negative bacteria susceptible only to colistin (COS) are emerging causes of severe nosocomial infections, reviving interest in the use of colistin. However, consensus on the most effective way to administer colistin has not yet been reached. METHODS: All patients who had sepsis due to COS gram-negative bacteria or minimally susceptible gram-negative bacteria and received intravenous colistimethate sodium (CMS) were prospectively enrolled. The CMS dosing schedule was based on a loading dose of 9 MU and a 9-MU twice-daily fractioned maintenance dose, titrated on renal function. For each CMS course, clinical cure, bacteriological clearance, daily serum creatinine clearance, and estimated creatinine clearance were recorded. RESULTS: Twenty-eight infectious episodes due to Acinetobacter baumannii (46.4%), Klebsiella pneumoniae (46.4%), and Pseudomonas aeruginosa (7.2%) were analyzed. The main types of infection were bloodstream infection (64.3%) and ventilator-associated pneumonia (35.7%). Clinical cure was observed in 23 cases (82.1%). Acute kidney injury developed during 5 treatment courses (17.8%), did not require renal replacement therapy, and subsided within 10 days from CMS discontinuation. No correlation was found between variation in serum creatinine level (from baseline to peak) and daily and cumulative doses of CMS, and between variation in serum creatinine level (from baseline to peak) and duration of CMS treatment. CONCLUSIONS: Our study shows that in severe infections due to COS gram-negative bacteria, the high-dose, extended-interval CMS regimen has a high efficacy, without significant renal toxicity. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/22423120/High-dose,_extended-interval_colistin_administration_in_critically_ill_patients:_is_this_the_right_dosing_strategy_A_preliminary_study. L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cis286 ER -