The necessity of a loading dose when prescribing intravenous colistin in critically ill patients with CRGNB-associated pneumonia: a multi-center observational study

Abstract

Background The importance or necessity of a loading dose when prescribing intravenous colistin has not been well established in clinical practice, and approximate one-third to half of patients with carbapenem-resistant gram-negative bacteria (CRGNB) infection did not receive the administration of a loading dose. The aim of this study is to investigate the efficacy and risk of acute kidney injury when prescribing intravenous colistin for critically ill patients with nosocomial pneumonia caused by CRGNB. Methods This was a multicenter, retrospective study that recruited ICU-admitted patients who had CRGNB-associated nosocomial pneumonia and were treated with intravenous colistin. Then, we classified the patients into colistin loading dose (N = 85) and nonloading dose groups (N = 127). After propensity-score matching for important covariates, we compared the mortality rate, clinical outcome and microbiological eradication rates between the groups (N = 67). Results The loading group had higher percentages of patients with favorable clinical outcomes (55.2% and 35.8%, p = 0.037) and microbiological eradication rates (50% and 27.3%, p = 0.042) at day 14 than the nonloading group. The mortality rates at days 7, 14 and 28 and overall in-hospital mortality were not different between the two groups, but the Kaplan–Meier analysis showed that the loading group had a longer survival time than the nonloading group. Furthermore, the loading group had a shorter length of hospital stay than the nonloading group (52 and 60, p = 0.037). Regarding nephrotoxicity, there was no significant difference in the risk of developing acute kidney injury between the groups. Conclusions The administration of a loading dose is recommended when prescribing intravenous colistin for critically ill patients with nosocomial pneumonia caused by CRGNB.

Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients: A meta-analysis

“…A total of 1437 results were retrieved from the search. After the removal of duplicates and title and abstract screening, 176 full texts were assessed for eligibility, and 89 studies were included for quantitative synthesis ( )[ 16 - 104 ]. The detailed study selection process is depicted in Figure 1 .…”

“…All studies were published from 2003 to 2022. Among the included studies, 9 were RCTs[ 16 , 18 , 23 , 34 , 35 , 54 , 57 , 81 , 87 ], 5 were case–control studies[ 31 , 47 , 51 , 74 , 86 ] and 75 were cohort studies[ 17 , 19 - 22 , 24 - 30 , 32 , 33 , 36 - 46 , 48 - 50 , 52 , 53 , 55 , 56 , 58 - 73 , 75 - 80 , 82 - 85 , 88 - 104 ]. The sample sizes per study ranged from 11 to 4910 critically ill patients.…”

“…The sample sizes per study ranged from 11 to 4910 critically ill patients. This systematic review and meta-analysis included 3 parallel cohort studies that reported outcome measures associated with colistin and PMB use[ 62 , 76 , 80 ], 2 studies with colistin and PMB use[ 17 , 68 ], 75 studies with colistin use alone[ 16 , 18 - 40 , 42 - 57 , 59 - 61 , 64 - 67 , 70 - 75 , 78 , 81 , 83 - 99 , 101 - 102 , 104 ] and 9 studies with PMB use alone[ 41 , 58 , 63 , 69 , 77 , 79 , 82 , 100 , 103 ]. Regarding the geographical distribution, 35 studies were conducted in Europe, 31 in Asia, 6 in North America, 6 in South America and 4 in Africa.…”

Efficacy and safety of polymyxin E sulfate in the treatment of critically ill patients with carbapenem-resistant organism infections

“…Numerous clinical efficacy rates on CMS and PBS varied from 45% to 88% (29) and 47.3% to 76% (9), respectively. Regarding the parameters impacting the efficacy of the other two medications, the loading dose (30)(31)(32), maintenance dose (33,34), and time of drug administration (35, 36), dosing regimen (33,(37)(38)(39), and combination of other agents (40,41) were the primary areas of concern. In the present investigation, the timing of PES administration, the loading dose, the shape of the loading dose, the mode of administration, and the type of combination were not significantly associated with efficacy based on the suggested maintenance dose.…”

The prevalence, presentation and outcome of colistin susceptible-only Acinetobacter Baumannii-associated pneumonia in intensive care unit: a multicenter observational study

“…Study population and data collection. This is a retrospective study conducted in five medical centers in Taiwan 13,14 . We recruited ICU-admitted patients who were diagnosed with carbapenem-resistant Gram-negative bacterial (CR-GNB) associated pneumonia from Jan. 2016 to Dec. 2016.…”