BACKGROUND: Colistin is increasingly used for the treatment of multidrug-resistant gram-negative infections. However, colistin dosing varies greatly and the optimal regimen is unknown. The purpose of this study was to determine if colistin dosing correlates with patient outcomes. METHODS: This retrospective study included patients with gram-negative bacteremia treated with intravenous colistin for at least 72 hours. The primary objective was to determine if colistin dose (mg of colistin base activity/kg/day) independently predicts day-7 microbiological success. Secondary objectives included evaluation for an association between colistin dose and 7-day mortality, 28-day mortality, and the development of acute kidney insufficiency (AKI). RESULTS: Seventy-six patients were included in the analysis, with 52 patients (68%) achieving 7-day microbiological success. The median colistin dose was significantly higher in patients who achieved microbiological success (2.9 vs 1.5 mg/kg/day; P = .011). After adjusting for baseline severity of illness and concomitant tigecyline use, higher colistin dose independently correlated with microbiological success (adjusted odds ratio per 1 mg/kg/day = 1.74; 95% confidence interval, 1.11-2.71; P = .015). The median colistin dose was also significantly higher among survivors at day 7 (2.7 vs 1.5 mg/kg/day; P = .007). However, no difference was observed in colistin dose when comparing survivors and nonsurvivors at day 28. A significantly higher colistin dose was given to patients who developed AKI during therapy (3.8 vs 1.6 mg/kg/day; P < .001). CONCLUSIONS: Higher colistin dose independently predicted microbiological success, which may partially explain the similar association with 7-day mortality. However, higher colistin doses may also precipitate worsening renal function.
BACKGROUND: Colistin is increasingly used for the treatment of multidrug-resistant gram-negative infections. However, colistin dosing varies greatly and the optimal regimen is unknown. The purpose of this study was to determine if colistin dosing correlates with patient outcomes. METHODS: This retrospective study included patients with gram-negative bacteremia treated with intravenous colistin for at least 72 hours. The primary objective was to determine if colistin dose (mg of colistin base activity/kg/day) independently predicts day-7 microbiological success. Secondary objectives included evaluation for an association between colistin dose and 7-day mortality, 28-day mortality, and the development of acute kidney insufficiency (AKI). RESULTS: Seventy-six patients were included in the analysis, with 52 patients (68%) achieving 7-day microbiological success. The median colistin dose was significantly higher in patients who achieved microbiological success (2.9 vs 1.5 mg/kg/day; P = .011). After adjusting for baseline severity of illness and concomitant tigecyline use, higher colistin dose independently correlated with microbiological success (adjusted odds ratio per 1 mg/kg/day = 1.74; 95% confidence interval, 1.11-2.71; P = .015). The median colistin dose was also significantly higher among survivors at day 7 (2.7 vs 1.5 mg/kg/day; P = .007). However, no difference was observed in colistin dose when comparing survivors and nonsurvivors at day 28. A significantly higher colistin dose was given to patients who developed AKI during therapy (3.8 vs 1.6 mg/kg/day; P < .001). CONCLUSIONS: Higher colistin dose independently predicted microbiological success, which may partially explain the similar association with 7-day mortality. However, higher colistin doses may also precipitate worsening renal function.
Authors: Brian C Nelson; Daniel P Eiras; Angela Gomez-Simmonds; Angela S Loo; Michael J Satlin; Stephen G Jenkins; Susan Whittier; David P Calfee; E Yoko Furuya; Christine J Kubin Journal: Antimicrob Agents Chemother Date: 2015-08-31 Impact factor: 5.191
Authors: Sameer S Kadri; Samuel F Hohmann; E John Orav; Stephanie L Bonne; Matthew A Moffa; Joseph G Timpone; Jeffrey R Strich; Tara Palmore; Kenneth B Christopher; Christy Varughese; David C Hooper; Robert L Danner Journal: Clin Infect Dis Date: 2014-09-22 Impact factor: 9.079
Authors: N L Parchem; K A Bauer; C H Cook; J E Mangino; C D Jones; K Porter; C V Murphy Journal: Eur J Clin Microbiol Infect Dis Date: 2016-05-26 Impact factor: 3.267
Authors: Sameer S Kadri; Jennifer Adjemian; Yi Ling Lai; Alicen B Spaulding; Emily Ricotta; D Rebecca Prevots; Tara N Palmore; Chanu Rhee; Michael Klompas; John P Dekker; John H Powers; Anthony F Suffredini; David C Hooper; Scott Fridkin; Robert L Danner Journal: Clin Infect Dis Date: 2018-11-28 Impact factor: 9.079
Authors: Jose M Munita; Samuel L Aitken; William R Miller; Federico Perez; Rossana Rosa; Luis A Shimose; Paola N Lichtenberger; Lilian M Abbo; Rupali Jain; Masayuki Nigo; Audrey Wanger; Rafael Araos; Truc T Tran; Javier Adachi; Robert Rakita; Samuel Shelburne; Robert A Bonomo; Cesar A Arias Journal: Clin Infect Dis Date: 2017-07-01 Impact factor: 9.079