Prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia

ABSTRACT: Objectives: Colistin, an important drug to treat carbapenem-resistant Acinetobacter baumannii (CRAB) infections, has a narrow therapeutic window with nephrotoxicity. This study was conducted to determine the importance of colistin concentrations in predicting nephrotoxicity when treating...

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Autores principales:	Yun-Jeong Jeong, Namyi Gu, Won Gun Kwack, Yunseong Kang, Seong Yeon Park, Young-Soon Yoon
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Carbapenem-resistant Acinetobacter baumannii Pneumonia Colistin Colistin methanesulfonate Nephrotoxicity Therapeutic drug monitoring Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/a8043ad844d341209a45ec772b28ae36
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spelling	oai:doaj.org-article:a8043ad844d341209a45ec772b28ae362021-11-30T04:15:54ZProspective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia2213-716510.1016/j.jgar.2021.10.017https://doaj.org/article/a8043ad844d341209a45ec772b28ae362021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2213716521002344https://doaj.org/toc/2213-7165ABSTRACT: Objectives: Colistin, an important drug to treat carbapenem-resistant Acinetobacter baumannii (CRAB) infections, has a narrow therapeutic window with nephrotoxicity. This study was conducted to determine the importance of colistin concentrations in predicting nephrotoxicity when treating CRAB pneumonia with colistin. Methods: A prospective cohort study was performed in one teaching hospital from May 2015 to January 2018. Patients with CRAB pneumonia were treated with intravenous colistin methanesulfonate (CMS) at 2.5–5.0 mg/kg/day. On Days 3 and 4, plasma colistin and CMS concentrations were determined by six serial blood samples (immediately prior to dosing and 1 h and 4 h after the end of infusion). Results: The 25 patients included in the analysis had hospital-acquired pneumonia caused by CRAB. Nephrotoxicity occurred in five patients (20%) on Day 7. There was no difference in clinical characteristics of patients with or without nephrotoxicity. The maximum plasma CMS concentration (mean ± standard deviation) was significantly higher in patients with nephrotoxicity on Day 7 than those without nephrotoxicity (15.3 ± 4.2 mg/L vs. 8.3 ± 3.8 mg/L; P = 0.014). The maximum plasma colistin concentration (Cmax,col) was significantly higher in the nephrotoxicity group on Day 7 (4.8 ± 2.0 mg/L vs. 2.1 ± 1.0 mg/L; P = 0.002). Cmax,col was lower in patients with microbiological failure than those without microbiological failure (1.92 mg/L vs. 3.01 mg/L; P = 0.038). Conclusion: This study confirmed that plasma levels of CMS and colistin, especially maximum levels, are important for predicting nephrotoxicity in patients with CRAB pneumonia. [ClinicalTrials.gov ID NCT02482961]Yun-Jeong JeongNamyi GuWon Gun KwackYunseong KangSeong Yeon ParkYoung-Soon YoonElsevierarticleCarbapenem-resistant Acinetobacter baumanniiPneumoniaColistinColistin methanesulfonateNephrotoxicityTherapeutic drug monitoringMicrobiologyQR1-502ENJournal of Global Antimicrobial Resistance, Vol 27, Iss , Pp 315-323 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Carbapenem-resistant Acinetobacter baumannii Pneumonia Colistin Colistin methanesulfonate Nephrotoxicity Therapeutic drug monitoring Microbiology QR1-502
spellingShingle	Carbapenem-resistant Acinetobacter baumannii Pneumonia Colistin Colistin methanesulfonate Nephrotoxicity Therapeutic drug monitoring Microbiology QR1-502 Yun-Jeong Jeong Namyi Gu Won Gun Kwack Yunseong Kang Seong Yeon Park Young-Soon Yoon Prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia
description	ABSTRACT: Objectives: Colistin, an important drug to treat carbapenem-resistant Acinetobacter baumannii (CRAB) infections, has a narrow therapeutic window with nephrotoxicity. This study was conducted to determine the importance of colistin concentrations in predicting nephrotoxicity when treating CRAB pneumonia with colistin. Methods: A prospective cohort study was performed in one teaching hospital from May 2015 to January 2018. Patients with CRAB pneumonia were treated with intravenous colistin methanesulfonate (CMS) at 2.5–5.0 mg/kg/day. On Days 3 and 4, plasma colistin and CMS concentrations were determined by six serial blood samples (immediately prior to dosing and 1 h and 4 h after the end of infusion). Results: The 25 patients included in the analysis had hospital-acquired pneumonia caused by CRAB. Nephrotoxicity occurred in five patients (20%) on Day 7. There was no difference in clinical characteristics of patients with or without nephrotoxicity. The maximum plasma CMS concentration (mean ± standard deviation) was significantly higher in patients with nephrotoxicity on Day 7 than those without nephrotoxicity (15.3 ± 4.2 mg/L vs. 8.3 ± 3.8 mg/L; P = 0.014). The maximum plasma colistin concentration (Cmax,col) was significantly higher in the nephrotoxicity group on Day 7 (4.8 ± 2.0 mg/L vs. 2.1 ± 1.0 mg/L; P = 0.002). Cmax,col was lower in patients with microbiological failure than those without microbiological failure (1.92 mg/L vs. 3.01 mg/L; P = 0.038). Conclusion: This study confirmed that plasma levels of CMS and colistin, especially maximum levels, are important for predicting nephrotoxicity in patients with CRAB pneumonia. [ClinicalTrials.gov ID NCT02482961]
format	article
author	Yun-Jeong Jeong Namyi Gu Won Gun Kwack Yunseong Kang Seong Yeon Park Young-Soon Yoon
author_facet	Yun-Jeong Jeong Namyi Gu Won Gun Kwack Yunseong Kang Seong Yeon Park Young-Soon Yoon
author_sort	Yun-Jeong Jeong
title	Prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia
title_short	Prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia
title_full	Prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia
title_fullStr	Prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia
title_full_unstemmed	Prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia
title_sort	prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant acinetobacter baumannii pneumonia
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/a8043ad844d341209a45ec772b28ae36
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Prospective observational study of the impact of plasma colistin levels in patients with carbapenem-resistant Acinetobacter baumannii pneumonia

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