Jessica L Elefritz1, Karri A Bauer1, Christian Jones2, Julie E Mangino3,4, Kyle Porter5, Claire V Murphy1. 1. 1 Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 2. 2 Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD, USA. 3. 3 Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. 4. 4 Department of Clinical Epidemiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 5. 5 Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
Abstract
INTRODUCTION: Emergence of multidrug-resistant (MDR) gram-negative (GN) pathogens and lack of novel antibiotics have increased the use of colistin, despite unknown optimal dosing. This study aimed to evaluate the safety and efficacy of a colistin loading dose, high-dose (LDHD) maintenance regimen in patients with MDR-GN pneumonia. METHODS: A retrospective cohort analysis was performed comparing critically ill patients with MDR-GN pneumonia pre- and postimplementation of a colistin LDHD guideline with a primary outcome of clinical cure. Safety was assessed using incidence of acute kidney injury (AKI) based on RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria. RESULTS: Seventy-two patients met the inclusion criteria (42 preimplementation and 30 postimplementation). Clinical cure was achieved in 23 (55%) patients in the preimplementation group and 20 (67%) patients in the postimplementation group ( P = .31). AKI occurred in 50% of the patients during the preimplementation period and 58% during the postimplementation period ( P = .59) with no difference in initiation rates of renal replacement therapy. CONCLUSION: The increased clinical cure rate after implementation of the colistin LDHD guideline did not reach statistical significance. The LDHD guideline, however, was not associated with an increased incidence of AKI, despite higher intravenous colistin doses. Opportunity exists to optimize colistin dosage while balancing toxicity, but larger studies are warranted.
INTRODUCTION: Emergence of multidrug-resistant (MDR) gram-negative (GN) pathogens and lack of novel antibiotics have increased the use of colistin, despite unknown optimal dosing. This study aimed to evaluate the safety and efficacy of a colistin loading dose, high-dose (LDHD) maintenance regimen in patients with MDR-GN pneumonia. METHODS: A retrospective cohort analysis was performed comparing critically ill patients with MDR-GN pneumonia pre- and postimplementation of a colistin LDHD guideline with a primary outcome of clinical cure. Safety was assessed using incidence of acute kidney injury (AKI) based on RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria. RESULTS: Seventy-two patients met the inclusion criteria (42 preimplementation and 30 postimplementation). Clinical cure was achieved in 23 (55%) patients in the preimplementation group and 20 (67%) patients in the postimplementation group ( P = .31). AKI occurred in 50% of the patients during the preimplementation period and 58% during the postimplementation period ( P = .59) with no difference in initiation rates of renal replacement therapy. CONCLUSION: The increased clinical cure rate after implementation of the colistin LDHD guideline did not reach statistical significance. The LDHD guideline, however, was not associated with an increased incidence of AKI, despite higher intravenous colistin doses. Opportunity exists to optimize colistin dosage while balancing toxicity, but larger studies are warranted.
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Authors: Abdulrahman I Alshaya; Khalid Bin Saleh; Mohammed Aldhaeefi; Hisham A Baderldin; Farris O Alamody; Qusai A Alhamdan; Mohammed A Almusallam; Omar Alshaya; Khalid Al Sulaiman; Shaima Alshareef; Shuroug A Alowais; Shmeylan A Al Harbi; Ghassan Alghamdi Journal: Infect Drug Resist Date: 2022-04-24 Impact factor: 4.003
Authors: Abdul Haseeb; Hani Saleh Faidah; Saleh Alghamdi; Amal F Alotaibi; Mahmoud Essam Elrggal; Ahmad Jamal Mahrous; Safa S Almarzoky Abuhussain; Najla A Obaid; Manal Algethamy; Abdullmoin AlQarni; Asim A Khogeer; Zikria Saleem; Aziz Sheikh Journal: Antibiotics (Basel) Date: 2021-11-26