Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2017

Open Access 01-12-2017 | Research article

Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa

Authors: Luisa Sorlí, Sonia Luque, Concepción Segura, Nuria Campillo, Milagro Montero, Erika Esteve, Sabina Herrera, Natividad Benito, Francisco Alvarez-Lerma, Santiago Grau, Juan Pablo Horcajada

Published in: BMC Infectious Diseases | Issue 1/2017

Login to get access

Abstract

Background

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.

Methods

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 (Css) were recorded. The primary and secondary end points were clinical cure and 30-day all-cause mortality.

Results

Ninety-one patients were included. Clinical cure was observed in 72 (79%) patients. The mean (SD) Css 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).

Conclusion

In this series of patients with infections caused by XDR P. aeruginosa infections, Css is not observed to be related to clinical outcome.
Literature
1.
Shorr AF. Review of studies of the impact on Gram-negative bacterial resistance on outcomes in the intensive care unit. Crit Care Med. 2009;37:1463–9. Department of Pulmonary and Critical Care Medicine, Washington Hospital Center, Washington DC, USA. afshorr@mail.dnamail.com.CrossRefPubMed
2.
Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:1–12. Division of Geographic Medicine and Infectious Diseases, Tufts University and Tufts Medical Center, Boston, Massachusetts 02111, USA. hboucher@tuftsmedicalcenter.org.CrossRefPubMed
3.
Payne DJ, Gwynn MN, Holmes DJ, Pompliano DL. Drugs for bad bugs: confronting the challenges of antibacterial discovery. Nat Rev Discov. 2007;6:29–40. Infectious Diseases Centre of Excellence for Drug Discovery, GlaxoSmithKline, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, USA.CrossRef
4.
Bergen PJ, Landersdorfer CB, Zhang J, Zhao M, Lee HJ, Nation RL, et al. Pharmacokinetics and pharmacodynamics of ‘old’ polymyxins: what is new? Diagn Microbiol Infect Dis. 2012;74:213–23. Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia.: Elsevier Inc.CrossRefPubMedPubMedCentral
5.
Michalopoulos AS, Karatza DC, Gregorakos L. Pharmacokinetic evaluation of colistin sodium. Expert Opin Drug Metab Toxicol. 2011;7:245–55. Intensive Care Unit, Henry Dunant Hospital, 107 Mesogeion Ave, 11528, Athens, Greece. amichalopoulos@hol.gr.CrossRefPubMed
6.
Garonzik SM, Li J, Thamlikitkul V, Paterson DL, Shoham S, Jacob J, et al. Population pharmacokinetics of colistin methanesulfonate and formed colistin in critically ill patients from a multicenter study provide dosing suggestions for various categories of patients. Antimicrob Agents Chemother. 2011;55:3284–94. School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, SUNY, Buffalo, New York, USA.CrossRefPubMedPubMedCentral
7.
Yahav D, Farbman L, Leibovici L, Paul M. Colistin: new lessons on an old antibiotic. Clin Microbiol Infect. 2012;18:18–29. Internal Medicine E, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel. dafna.yahav@gmail.com: European Society of Clinical Microbiology and Infectious Diseases. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​22168320.CrossRefPubMed
8.
Falagas ME, Rafailidis PI, Ioannidou E, Alexiou VG, Matthaiou DK, Karageorgopoulos DE, et al. Colistin therapy for microbiologically documented multidrug-resistant Gram-negative bacterial infections: a retrospective cohort study of 258 patients. Int J Antimicrob Agents. 2010;35:194–9. Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 15 123 Marousi, Athens, Greece. m.falagas@aibs.gr: Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.CrossRefPubMed
9.
Montero M, Horcajada JP, Sorli L, Alvarez-Lerma F, Grau S, Riu M, et al. Effectiveness and safety of colistin for the treatment of multidrug-resistant Pseudomonas aeruginosa infections. Infection. 2009;37:461–5. Dept. of Internal Medicine and Infectious Diseases, Hospital del Mar, Autonomous University of Barcelona, Barcelona, Spain. 95422@imas.imim.es.CrossRefPubMed
10.
Dalfino L, Puntillo F, Mosca A, Monno R, Spada ML, Coppolecchia S, et al. High-dose, extended-interval colistin administration in critically ill patients: is this the right dosing strategy? A preliminary study. Clin Infect Dis. 2012;54:1720–6. Anesthesia and Intensive Care Unit, Department of Emergeny and Organ Transplantion.CrossRefPubMedPubMedCentral
11.
Paul M, Bishara J, Levcovich A, Chowers M, Goldberg E, Singer P, et al. Effectiveness and safety of colistin: prospective comparative cohort study. J Antimicrob Chemother. 2010;65:1019–27. Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. paulm@post.tau.ac.il. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​20299494.CrossRefPubMed
12.
13.
Foundation NK. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.
14.
Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–51. Department of Medicine, Cornell Arthritis and Musculoskeletal Disease Center, Hospital for Special Surgery, New York, NY, USA.CrossRefPubMed
15.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMed
16.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008;36:309–32. National Healthcare Safety Network, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. thoran@cdc.gov. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​18538699.CrossRefPubMed
17.
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 1992;20:864–74.
18.
19.
Li J, Milne RW, Nation RL, Turnidge JD, Coulthard K, Johnson DW. A simple method for the assay of colistin in human plasma, using pre-column derivatization with 9-fluorenylmethyl chloroformate in solid-phase extraction cartridges and reversed-phase high-performance liquid chromatography. J Chromatogr Biomed Sci Appl. 2001;761:167–75. Centre for Pharmaceutical Research, University of South Australia, Adelaide Australia.CrossRef
20.
21.
Couet W, Gregoire N, Marchand S, Mimoz O. Colistin pharmacokinetics: the fog is lifting. Clin Microbiol Infect. 2012;18:30–9. Inserm ERI-23, CHU, Service de Toxicologie et Pharmacocinetique, UFR Medecine-Pharmacie, Universite de Poitiers Intensive Care Unit, University Hospital of Poitiers, Poitiers, France.: European Society of Clinical Microbiology and Infectious Diseases.CrossRefPubMed
22.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, ADQI. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12. Department of Intensive Care and Medicine, Austin Health, Melbourne, Australia. rinaldo.bellomo@austin.org.au.CrossRefPubMedPubMedCentral
23.
Levin AS, Barone AA, Penco J, Santos MV, Marinho IS, Arruda EA, et al. Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis. 1999;28:1008–11. Hospital Infection Control Department, Hospital das Clinicas, Faculdade de Medicina, University of Sao Paulo, SP, Brazil. nivel@usp.br.CrossRefPubMed
24.
Cheng CY, Sheng WH, Wang JT, Chen YC, Chang SC. Safety and efficacy of intravenous colistin (colistin methanesulphonate) for severe multidrug-resistant Gram-negative bacterial infections. Int J Antimicrob Agents. 2010;35:297–300. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.: Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.CrossRefPubMed
25.
Markou N, Apostolakos H, Koumoudiou C, Athanasiou M, Koutsoukou A, Alamanos I, et al. Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit Care. 2003;7:R78–83. Intensive Care Unit B, Athens Trauma Hospital KAT, Athens, Greece. nikolaos_markou@hotmail.com.CrossRefPubMedPubMedCentral
26.
Plachouras D, Karvanen M, Friberg LE, Papadomichelakis E, Antoniadou A, Tsangaris I, et al. Population pharmacokinetic analysis of colistin methanesulfonate and colistin after intravenous administration in critically ill patients with infections caused by gram-negative bacteria. Antimicrob Agents Chemother. 2009;53:3430–6. 4th Department of Internal Medicine, Attikon University General Hospital, Haidari 12462, Greece. dplach@med.uoa.gr.CrossRefPubMedPubMedCentral
27.
28.
Yilmaz GR, Bastug AT, But A, Yildiz S, Yetkin MA, Kanyilmaz D, et al. Clinical and microbiological efficacy and toxicity of colistin in patients infected with multidrug-resistant gram-negative pathogens. J Infect Chemother. 2013;19:57–62. Infectious Diseases and Clinical Microbiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey. ruhsar6@yahoo.com.CrossRefPubMed
29.
Zaidi ST, Al Omran S, Al Aithan AS, Al Sultan M. Efficacy and safety of low-dose colistin in the treatment for infections caused by multidrug-resistant gram-negative bacteria. J Clin Pharm Ther. 2014;39(3):272–6.CrossRefPubMed
30.
Khawcharoenporn T, Pruetpongpun N, Tiamsak P, Rutchanawech S, Mundy LM, Apisarnthanarak A. Colistin-based treatment for extensively drug-resistant Acinetobacter baumannii pneumonia. Int J Antimicrob Agents. 2014;43:378–82.CrossRefPubMed
31.
32.
33.
34.
Metadata
Title
Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
Authors
Luisa Sorlí
Sonia Luque
Concepción Segura
Nuria Campillo
Milagro Montero
Erika Esteve
Sabina Herrera
Natividad Benito
Francisco Alvarez-Lerma
Santiago Grau
Juan Pablo Horcajada
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2017
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-016-2117-7

Other articles of this Issue 1/2017

BMC Infectious Diseases 1/2017 Go to the issue

Research article

ICU-treated influenza A(H1N1) pdm09 infections more severe post pandemic than during 2009 pandemic: a retrospective analysis

Research article

Caretakers’ understanding of malaria, use of insecticide treated net and care seeking-behavior for febrile illness of their children in Ethiopia

Research article

Validity and reliability of the tuberculosis-related stigma scale version for Brazilian Portuguese

Case report

Screening for genital tuberculosis in a limited resource country: case report

Research article

Prevalence and incidence of external genital warts in a sample of Italian general female population

Research article

Outbreak of caliciviruses in the Singapore military, 2015
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits