Title |
Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
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Published in |
BMC Infectious Diseases, January 2017
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DOI | 10.1186/s12879-016-2117-7 |
Pubmed ID | |
Authors |
Luisa Sorlí, Sonia Luque, Concepción Segura, Nuria Campillo, Milagro Montero, Erika Esteve, Sabina Herrera, Natividad Benito, Francisco Alvarez-Lerma, Santiago Grau, Juan Pablo Horcajada |
Abstract |
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. 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. 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). In this series of patients with infections caused by XDR P. aeruginosa infections, Css is not observed to be related to clinical outcome. |
X Demographics
Geographical breakdown
Country | Count | As % |
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Spain | 3 | 43% |
South Africa | 2 | 29% |
Unknown | 2 | 29% |
Demographic breakdown
Type | Count | As % |
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Members of the public | 6 | 86% |
Scientists | 1 | 14% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
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Unknown | 68 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
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Student > Master | 11 | 16% |
Researcher | 10 | 15% |
Student > Bachelor | 9 | 13% |
Other | 7 | 10% |
Student > Ph. D. Student | 6 | 9% |
Other | 14 | 21% |
Unknown | 11 | 16% |
Readers by discipline | Count | As % |
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Medicine and Dentistry | 18 | 26% |
Pharmacology, Toxicology and Pharmaceutical Science | 12 | 18% |
Biochemistry, Genetics and Molecular Biology | 5 | 7% |
Agricultural and Biological Sciences | 5 | 7% |
Immunology and Microbiology | 2 | 3% |
Other | 8 | 12% |
Unknown | 18 | 26% |