Title:
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Impact of colistin plasma levels on the clinical outcome of patients with infections caused by extremely drug-resistant Pseudomonas aeruginosa
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Author:
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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
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Abstract:
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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. |
Abstract:
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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). |
Subject(s):
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-Colistin -Mortality -Plasma concentration -Pseudomonas aeruginosa -Extremely drug-resistant -Nephrotoxicity |
Rights:
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© 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.
http://creativecommons.org/licenses/by/4.0/ |
Document type:
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Article Article - Published version |
Published by:
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BioMed Central
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