Colistin for the treatment of urinary tract infections caused by extremely drug-resistant Pseudomonas aeruginosa: Dose is critical.
Aged
Anti-Bacterial Agents
/ administration & dosage
Colistin
/ administration & dosage
Drug Resistance, Multiple, Bacterial
Female
Humans
Kidney
/ drug effects
Male
Microbial Sensitivity Tests
Middle Aged
Prospective Studies
Pseudomonas Infections
/ drug therapy
Pseudomonas aeruginosa
/ drug effects
Treatment Outcome
Urinary Tract Infections
/ drug therapy
Colistin plasma concentrations
Colistin-associated nephrotoxicity
Urinary tract infections
Journal
The Journal of infection
ISSN: 1532-2742
Titre abrégé: J Infect
Pays: England
ID NLM: 7908424
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
13
01
2019
revised:
15
06
2019
accepted:
20
06
2019
pubmed:
3
7
2019
medline:
11
7
2020
entrez:
3
7
2019
Statut:
ppublish
Résumé
Optimal dosage regimens of colistin for the treatment of urinary tract infections (UTI) are unknown. Colistimethate sodium (CMS), the inactive prodrug of colistin, is mainly excreted in urine and converts to colistin after filtration by glomeruli, suggesting that concentrations of colistin in urine could be much higher than in plasma. Therefore, there is a need to optimize dosage regimens of intravenous CMS for UTI. The aim of this study was to examine the relationship between AUC/MIC of formed colistin and clinical outcomes in patients with UTI caused by extremely drug resistant (XDR) Pseudomonas aeruginosa. This prospective, observational cohort study involved patients with UTI caused by XDR P. aeruginosa. Clinical cure, bacteriological clearance and acute kidney injury (AKI) were analyzed. Steady-state colistin plasma concentrations (C Thirty-three patients were included (24 lower UTI and 9 pyelonephritis). The MIC The currently recommended dosage regimens of CMS showed high efficacy for the treatment of lower complicated UTI caused by XDR P. aeruginosa in non-critically ill patients and in the case of low MIC values, but also a considerable nephrotoxicity rate. Our data suggest that the use of lower CMS doses for lower UTI should be investigated in future studies to minimize the unnecessary nephrotoxicity.
Identifiants
pubmed: 31265867
pii: S0163-4453(19)30192-6
doi: 10.1016/j.jinf.2019.06.011
pmc: PMC7265153
mid: NIHMS1590924
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Colistin
Z67X93HJG1
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
253-261Subventions
Organisme : NIAID NIH HHS
ID : R01 AI132154
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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