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

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

Research output: Contribution to journalArticleResearchpeer-review

22 Citations (Scopus)

Abstract

© 2017 The Author(s). 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.
Original languageEnglish
Article number11
JournalBMC Infectious Diseases
Volume17
Issue number1
DOIs
Publication statusPublished - 5 Jan 2017

Keywords

  • Colistin
  • Extremely drug-resistant
  • Mortality
  • Nephrotoxicity
  • Plasma concentration
  • Pseudomonas aeruginosa

Fingerprint Dive into the research topics of 'Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa'. Together they form a unique fingerprint.

Cite this