Differences in Colistin Administration and Bacterial and Treatment Outcomes in Critically Ill Patients

Abstract

The desired target steady-state average colistin concentration (C ss,avg ) to balance between therapeutic effectiveness and nephrotoxicity is largely unclear. The objective of this study was to evaluate the effect of the desired target colistin C ss,avg on the effectiveness and safety of IV colistin therapy in critically ill patients. Overall, 153 critically ill patients (71% males) receiving IV colistin were retrospectively analyzed. The desired target colistin C ss,avg was estimated based on the daily colistin dose and creatinine clearance of each patient. No significant predictor for clinical cure was identified. However, microbiological outcome was significantly associated with pneumonia compared to bacteremia (odds ratio [OR] 0.092, 95% confidence interval [CI] [0.033–0.251], P < 0.001) and the use of IV colistin loading dose (OR 2.783, 95% CI [1.126–6.880], P = 0.027). Colistin-associated nephrotoxicity was significantly less likely to occur in patients who received inhaled colistin close to the time of IV colistin therapy (OR 0.331, CI [0.119–0.925], P = 0.035). The desired target C ss,avg of colistin was not associated with treatment outcomes or the risk of nephrotoxicity. Loading dose and inhaled colistin use near the time of IV colistin therapy may be considered to maximize therapeutic effectiveness and minimize the risk of colistin-associated nephrotoxicity, respectively.

Steady‐state pharmacokinetic and pharmacodynamic profiling of colistin in critically ill patients with multi‐drug–resistant gram‐negative bacterial infections, along with differences in clinical, microbiological and safety outcome

“…38 Earlier studies have determined that the microbiological outcome after CMS therapy is associated with highdose therapy, presence of loading dose and type/severity of underlying illness. 26,39 In our study, we did not find any predictor significantly (P < .05) associated with the microbiological outcome. As our study design was different as compared to other previous studies, we could not include patients receiving high-dose CMS therapy or loading doses of CMS to determine their influence on the microbiological outcome.…”

“…9,10,21,25 We observed that the APACHE II score was significantly (P < .05) associated with the clinical outcome following CMS therapy, which was consistent with the suggestions of previous reports. 26,27 None of the parameters that we tested were associated/correlated with the microbiological outcome. Also, our findings suggested that the presence or absence of ADRs due to CMS therapy was significantly (P < .05) correlated and associated with C max , AUC 0-8 , CL and V d .…”

A Comparison of Colistin versus Colistin Plus Meropenem for the Treatment of Carbapenem-Resistant Acinetobacter baumannii in Critically Ill Patients: A Propensity Score-Matched Analysis

“…Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are a serious problem and increasing worldwide, particularly in the intensive care unit (ICU) [ 1 , 2 ]. The incidence of A. baumannii in ICU in Europe, Eastern Mediterranean and Africa was 56.5 cases per 1000 patients.…”

“…The mortality rate of A. baumannii infection in hospital was 35.3% and of CRAB-related infection in ICU was 60.1% [ 1 ]. Due to altered physiological characteristics related to critical illness and the care provided in an ICU, such as the common use of carbapenem and invasive procedures, critically ill patients are more susceptible to CRAB infections associated with substantially increased morbidity and mortality [ 2 ].…”

“…Colistin is an important antimicrobial agent for the treatment of CRAB infections [ 2 , 5 ]. Increasing rates of carbapenem resistance have led to widespread use of colistin to treat the diverse infectious diseases caused by A. baumannii [ 5 , 6 ].…”