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Efficacy of loading dose of colistin in Acinetobacter baumannii ventilator-associated pneumonia.

Abstract

Colistin loading dose (LD) has been postulated as an advance in therapy. The clinical, microbiological effectiveness and nephrotoxicity of adding an LD to systemic colistin in ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) Acinetobacter baumannii remain unknown. In this quasi experimental study, the efficacy, outcomes and nephrotoxicity in 30 adults who received intravenous colistin with LD for MDR A. baumannii ventilator associated pneumonia were compared with 22 in absence of LD. Adding LD, the clinical cure rate at 14 days of therapy increased from 47.6% to 56.7% (p>0.397). No significant differences in bacteriological clearance (80 vs 81%), ICU mortality (50% vs 54.2%) or ICU length of stay (median: 32 vs 36 days) were identified. Mortality increased (76.2% vs 35.5%, p=0.004) in patients with nephrotoxicity, with age (median 67.0 vs. 50.0 years, p=0.002) being the only risk factor for nephrotoxicity. The nephrotoxicity rate increased from 27.3% in absence of LD to 35.3% with LD and SOFA <8, and 69.2% (p= 0.065) with LD and SOFA >7. Overall, nephrotoxicity was more severe in the LD group according to RIFLE criteria (p=0.015). Adding LD to systemic colistin for MDR A. baumannii VAP had no significant effect on clinical cure rates, bacteriologic clearance or pre-defined outcomes. However, the nephrotoxicity rate increased with LD, with special risk in adults with high organ failure development or advanced age. Further evidence regarding the risks and benefits of LD is required. The development of newer agents and strategies is urgently needed.

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  • Authors+Show Affiliations

    ,

    Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Erciyes, Turkey: Infection Control Committee, Faculty of Medicine, Erciyes University, Erciyes, Turkey.

    ,

    Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Erciyes, Turkey.

    ,

    Department of Internal Medicine, Intensive Care Unit, Faculty of Medicine, Erciyes University, Erciyes, Turkey.

    ,

    Infection Control Committee, Faculty of Medicine, Erciyes University, Erciyes, Turkey.

    ,

    Department of Anesthesiology and Reanimation, Intensive Care Unit, Faculty of Medicine, Erciyes University, Erciyes, Turkey.

    Critical Care Department, Hospital Vall d'Hebron, CIBERES, Universitat Autonoma de Barcelona, Barcelona, Spain.

    Source

    MeSH

    Acinetobacter Infections
    Acinetobacter baumannii
    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Colistin
    Drug Resistance, Multiple, Bacterial
    Female
    Humans
    Kidney Diseases
    Male
    Middle Aged
    Pneumonia, Ventilator-Associated
    Retrospective Studies
    Sepsis
    Young Adult

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    29286009

    Citation

    Alp, Emine, et al. "Efficacy of Loading Dose of Colistin in Acinetobacter Baumannii Ventilator-associated Pneumonia." Le Infezioni in Medicina : Rivista Periodica Di Eziologia, Epidemiologia, Diagnostica, Clinica E Terapia Delle Patologie Infettive, vol. 25, no. 4, 2017, pp. 311-319.
    Alp E, Eren E, Elay G, et al. Efficacy of loading dose of colistin in Acinetobacter baumannii ventilator-associated pneumonia. Infez Med. 2017;25(4):311-319.
    Alp, E., Eren, E., Elay, G., Cevahir, F., Esmaoğlu, A., & Rello, J. (2017). Efficacy of loading dose of colistin in Acinetobacter baumannii ventilator-associated pneumonia. Le Infezioni in Medicina : Rivista Periodica Di Eziologia, Epidemiologia, Diagnostica, Clinica E Terapia Delle Patologie Infettive, 25(4), pp. 311-319.
    Alp E, et al. Efficacy of Loading Dose of Colistin in Acinetobacter Baumannii Ventilator-associated Pneumonia. Infez Med. 2017 Dec 1;25(4):311-319. PubMed PMID: 29286009.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Efficacy of loading dose of colistin in Acinetobacter baumannii ventilator-associated pneumonia. AU - Alp,Emine, AU - Eren,Esma, AU - Elay,Gülseren, AU - Cevahir,Fatma, AU - Esmaoğlu,Aliye, AU - Rello,Jordi, PY - 2017/12/30/entrez PY - 2017/12/30/pubmed PY - 2018/8/30/medline SP - 311 EP - 319 JF - Le infezioni in medicina : rivista periodica di eziologia, epidemiologia, diagnostica, clinica e terapia delle patologie infettive JO - Infez Med VL - 25 IS - 4 N2 - Colistin loading dose (LD) has been postulated as an advance in therapy. The clinical, microbiological effectiveness and nephrotoxicity of adding an LD to systemic colistin in ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) Acinetobacter baumannii remain unknown. In this quasi experimental study, the efficacy, outcomes and nephrotoxicity in 30 adults who received intravenous colistin with LD for MDR A. baumannii ventilator associated pneumonia were compared with 22 in absence of LD. Adding LD, the clinical cure rate at 14 days of therapy increased from 47.6% to 56.7% (p>0.397). No significant differences in bacteriological clearance (80 vs 81%), ICU mortality (50% vs 54.2%) or ICU length of stay (median: 32 vs 36 days) were identified. Mortality increased (76.2% vs 35.5%, p=0.004) in patients with nephrotoxicity, with age (median 67.0 vs. 50.0 years, p=0.002) being the only risk factor for nephrotoxicity. The nephrotoxicity rate increased from 27.3% in absence of LD to 35.3% with LD and SOFA <8, and 69.2% (p= 0.065) with LD and SOFA >7. Overall, nephrotoxicity was more severe in the LD group according to RIFLE criteria (p=0.015). Adding LD to systemic colistin for MDR A. baumannii VAP had no significant effect on clinical cure rates, bacteriologic clearance or pre-defined outcomes. However, the nephrotoxicity rate increased with LD, with special risk in adults with high organ failure development or advanced age. Further evidence regarding the risks and benefits of LD is required. The development of newer agents and strategies is urgently needed. SN - 1124-9390 UR - https://www.unboundmedicine.com/medline/citation/29286009/Efficacy_of_loading_dose_of_colistin_in_Acinetobacter_baumannii_ventilator-associated_pneumonia L2 - http://www.infezmed.it/index.php/article?Anno=2017&amp;numero=4&amp;ArticoloDaVisualizzare=Vol_25_4_2017_311 DB - PRIME DP - Unbound Medicine ER -