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

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

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

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dc.contributor.author Sorli Redó, M. Luisaca
dc.contributor.author Luque Pardos, Sòniaca
dc.contributor.author Segura, Concepciónca
dc.contributor.author Campillo Ambrós, Núriaca
dc.contributor.author Montero, Maria Milagroca
dc.contributor.author Esteve, Erikaca
dc.contributor.author Herrera, Sabinaca
dc.contributor.author Benito, Natividadca
dc.contributor.author Álvarez Lerma, Franciscoca
dc.contributor.author Grau Cerrato, Santiagoca
dc.contributor.author Horcajada Gallego, Juan Pabloca
dc.date.accessioned 2017-07-13T06:48:40Z
dc.date.available 2017-07-13T06:48:40Z
dc.date.issued 2017
dc.description.abstract 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.
dc.description.sponsorship 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).
dc.format.mimetype application/pdfca
dc.identifier.citation Sorli Redó ML, Luque Pardos S, Segura C, Campillo Ambrós N, Montero MM, Esteve E et al. Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa. BMC Infectious Diseases. 2017;17(1):11. DOI: 10.1186/s12879-016-2117-7
dc.identifier.doi http://dx.doi.org/10.1186/s12879-016-2117-7
dc.identifier.issn 1471-2334
dc.identifier.uri http://hdl.handle.net/10230/32533
dc.language.iso eng
dc.publisher BioMed Centralca
dc.relation.ispartof BMC Infectious Diseases. 2017;17(1):11
dc.rights © 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.
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.rights.uri http://creativecommons.org/licenses/by/4.0/
dc.subject.keyword Colistin
dc.subject.keyword Mortality
dc.subject.keyword Plasma concentration
dc.subject.keyword Pseudomonas aeruginosa
dc.subject.keyword Extremely drug-resistant
dc.subject.keyword Nephrotoxicity
dc.title Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosaca
dc.type info:eu-repo/semantics/article
dc.type.version info:eu-repo/semantics/publishedVersion

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