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

BMC Infectious Diseases

Research Article

Erika Esteve¹  Sabina Herrera¹  Milagro Montero²  Juan Pablo Horcajada³  Luisa Sorlí⁴  Natividad Benito⁵  Concepción Segura⁶  Nuria Campillo⁷  Sonia Luque⁷  Santiago Grau⁸  Francisco Alvarez-Lerma⁹ 

[1] Infectious Disease Service, Hospital del Mar, Barcelona, Spain;Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;Infectious Disease Service, Hospital del Mar, Barcelona, Spain;Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;CIBERES, Madrid, Spain;Infectious Disease Service, Hospital del Mar, Barcelona, Spain;Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;Intensive Care Unit, Hospital del Mar, Barcelona, Spain;Universitat Autònoma de Barcelona, Barcelona, Spain;CEXS-Universitat Pompeu Fabra, Barcelona, Spain;Infectious Disease Service, Hospital del Mar, Barcelona, Spain;Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;Universitat Autònoma de Barcelona, Barcelona, Spain;CEXS-Universitat Pompeu Fabra, Barcelona, Spain;InfectiousDiseaseUnit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain;Institut d’Investigació Biomèdica Sant Pau, Barcelona, Spain;CIBERES, Madrid, Spain;Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;Laboratori de Referència de Catalunya, Prat de Llobregat, Spain;Pharmacy Service, Hospital del Mar, Barcelona, Spain;Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;Pharmacy Service, Hospital del Mar, Barcelona, Spain;Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;CIBERES, Madrid, Spain;Spanish Network for Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain;Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain;CIBERES, Madrid, Spain;

关键词: Colistin;    Mortality;    Plasma concentration;    Pseudomonas aeruginosa;    Extremely drug-resistant;    Nephrotoxicity;   

DOI  :  10.1186/s12879-016-2117-7

 received in 2016-04-20, accepted in 2016-12-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundColistin has a narrow therapeutic window with nephrotoxicity being the major dose-limiting adverse effect. Currently, the optimal doses and therapeutic plasma levels are unknown.MethodsProspective 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.ResultsNinety-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).ConclusionIn this series of patients with infections caused by XDR P. aeruginosa infections, Css is not observed to be related to clinical outcome.

【 授权许可】

CC BY   
© The Author(s). 2017