Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
Sorlí, Luisa (Universitat Autònoma de Barcelona)
Luque, Sonia (Institut Hospital del Mar d'Investigacions Mèdiques)
Segura, Concepción (Laboratori de Referència de Catalunya (El Prat de Llobregat, Catalunya))
Campillo, Núria (Institut Hospital del Mar d'Investigacions Mèdiques)
Montero, Milagro (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Esteve, Erika (Institut Hospital del Mar d'Investigacions Mèdiques)
Herrera, Sabina (Institut Hospital del Mar d'Investigacions Mèdiques)
Benito, Natividad (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Álvarez Lerma, Francisco (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Grau, Santiago (Centro de Investigación Biomédica en Red de Enfermedades Respiratorias)
Horcajada, Juan Pablo (Universitat Autònoma de Barcelona)

Date:	2017
Abstract:	Colistin has a narrow therapeutic window with nephrotoxicity being the major dose-limiting adverse effect. Currently, the optimal doses and therapeutic plasma levels are unknown. Prospective observational cohort study, including patients infected by colistin-susceptible P. aeruginosa treated with intravenous colistimethate sodium (CMS). Clinical data and colistin plasma levels at steady-state (C) were recorded. The primary and secondary end points were clinical cure and 30-day all-cause mortality. Ninety-one patients were included. Clinical cure was observed in 72 (79%) patients. The mean (SD) C was 1. 49 (1. 4) mg/L and 2. 42 (1. 5) mg/L (p = 0. 01) in patients who achieved clinical cure and those who not, respectively. Independent risk factors for clinical failure were male sex (OR 5. 88; 95% CI 1. 09-31. 63), APACHE II score (OR 1. 15; 95% CI 1. 03-1. 27) and nephrotoxicity at the EOT (OR 9. 13; 95% CI 95% 2. 06-40. 5). The 30-day mortality rate was 30. 8%. Risk factors for 30-day mortality included the APACHE II score (OR 1. 98; 95% CI 1-1. 20), the McCabe score (OR 2. 49; 95% CI 1. 14-5. 43) and the presence of nephrotoxicity at the end of treatment (EOT) (OR 3. 8; 95% CI 1. 26-11. 47). In this series of patients with infections caused by XDR P. aeruginosa infections, C is not observed to be related to clinical outcome.
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Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Colistin ; Mortality ; Plasma concentration ; Pseudomonas aeruginosa ; Extremely drug-resistant ; Nephrotoxicity
Published in:	BMC Infectious diseases, Vol. 17 (january 2017) , ISSN 1471-2334

DOI: 10.1186/s12879-016-2117-7
PMID: 28056821

9 p, 446.3 KB

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