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

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. aerug...

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Autores: Sorli Redó, M. Luisa, Luque Pardos, Sònia, Segura, Concepción, Campillo Ambrós, Núria, Montero, Maria Milagro, Esteve, Erika, Herrera, Sabina, Benito, Natividad, Álvarez Lerma, Francisco, Grau Cerrato, Santiago, Horcajada Gallego, Juan Pablo
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2017
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/32533
Acceso en línea:http://hdl.handle.net/10230/32533
http://dx.doi.org/10.1186/s12879-016-2117-7
Access Level:acceso abierto
Palabra clave:Colistin
Mortality
Plasma concentration
Pseudomonas aeruginosa
Extremely drug-resistant
Nephrotoxicity
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spelling Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosaSorli Redó, M. LuisaLuque Pardos, SòniaSegura, ConcepciónCampillo Ambrós, NúriaMontero, Maria MilagroEsteve, ErikaHerrera, SabinaBenito, NatividadÁlvarez Lerma, FranciscoGrau Cerrato, SantiagoHorcajada Gallego, Juan PabloColistinMortalityPlasma concentrationPseudomonas aeruginosaExtremely drug-resistantNephrotoxicityBackground: 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.This work was supported by Fondo de Investigación Sanitaria (FIS) from Instituto de Salud Carlos III, Spanish Ministry of Health, Grant number PS09/01634 and from Spanish Ministry of Health and Social Policy, General Pharmacy Subdirection, Grant numbers EC10-165 and EC11-318. This study also received funding from European Regional Development Fund (FEDER: “A way of making Europe”). NB was funded by the Ministerio de Economía y Competitividad, Instituto de Salud Carlos III and cofinanced by the European Development Regional Fund "A way to achieve Europe", Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015).BioMed Central201720172017info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/32533http://dx.doi.org/10.1186/s12879-016-2117-7reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésBMC Infectious Diseases. 2017;17(1):11© Sorlí L, Luque S, Segura C, Campillo N, Montero M, Esteve E, Herrera S, Benito N, Alvarez-LErma F, Grau S, Horcajada Gallego JP. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.http://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/325332026-06-12T07:21:37Z
dc.title.none.fl_str_mv Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
title Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
spellingShingle Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
Sorli Redó, M. Luisa
Colistin
Mortality
Plasma concentration
Pseudomonas aeruginosa
Extremely drug-resistant
Nephrotoxicity
title_short Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
title_full Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
title_fullStr Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
title_full_unstemmed Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
title_sort Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
dc.creator.none.fl_str_mv Sorli Redó, M. Luisa
Luque Pardos, Sònia
Segura, Concepción
Campillo Ambrós, Núria
Montero, Maria Milagro
Esteve, Erika
Herrera, Sabina
Benito, Natividad
Álvarez Lerma, Francisco
Grau Cerrato, Santiago
Horcajada Gallego, Juan Pablo
author Sorli Redó, M. Luisa
author_facet Sorli Redó, M. Luisa
Luque Pardos, Sònia
Segura, Concepción
Campillo Ambrós, Núria
Montero, Maria Milagro
Esteve, Erika
Herrera, Sabina
Benito, Natividad
Álvarez Lerma, Francisco
Grau Cerrato, Santiago
Horcajada Gallego, Juan Pablo
author_role author
author2 Luque Pardos, Sònia
Segura, Concepción
Campillo Ambrós, Núria
Montero, Maria Milagro
Esteve, Erika
Herrera, Sabina
Benito, Natividad
Álvarez Lerma, Francisco
Grau Cerrato, Santiago
Horcajada Gallego, Juan Pablo
author2_role author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Colistin
Mortality
Plasma concentration
Pseudomonas aeruginosa
Extremely drug-resistant
Nephrotoxicity
topic Colistin
Mortality
Plasma concentration
Pseudomonas aeruginosa
Extremely drug-resistant
Nephrotoxicity
description 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.
publishDate 2017
dc.date.none.fl_str_mv 2017
2017
2017
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/32533
http://dx.doi.org/10.1186/s12879-016-2117-7
url http://hdl.handle.net/10230/32533
http://dx.doi.org/10.1186/s12879-016-2117-7
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv BMC Infectious Diseases. 2017;17(1):11
dc.rights.none.fl_str_mv http://creativecommons.org/licenses/by/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
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