Treatment of Ventilator-associated Pneumonia with High-dose Colistin Under Continuous Veno-venous Hemofiltration.
acute kidney injury
colistin
continuous veno-venous hemofiltration
nephrotoxicity
ventilator-associated pneumonia
Journal
Journal of translational internal medicine
ISSN: 2450-131X
Titre abrégé: J Transl Int Med
Pays: Poland
ID NLM: 101673826
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
entrez:
23
10
2019
pubmed:
23
10
2019
medline:
23
10
2019
Statut:
epublish
Résumé
High-dose colistin (COL) ensures adequate treatment of pneumonia caused by multidrug resistant gram-negative bacteria (MDR-GNB) but must be weighed against a higher risk of nephrotoxicity. Continuous veno-venous hemofiltration (CVVH) clears COL by filtering and membrane adsorption that permits to avoid dose accumulation and excessively high peak concentrations. We evaluated clinical/microbiological efficacy of the high-dose COL treatment under CVVH in patients with newly diagnosed MDR-GNB ventilator-associated pneumonia (VAP). Observational cohort study in critically ill adult patients with MDR-GNB VAP. Colistimethate sodium (CMS) was administered as a 9 million international units (MIU) of loading dose followed by 3 × 4.5 MIU daily. CVVH was performed over a highly adsorptive membrane. Clinical and microbiological efficacies were assessed at the end of therapy. In survivors, serum creatinine level was evaluated before and at the end of therapy. Fourteen patients (8 male patients, aged 57 ± 14 years) were consecutively included. Isolated pathogens were In patients with MDR-GNB VAP, CVVH may represent an interesting option to enable effective high-dose COL treatment.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
High-dose colistin (COL) ensures adequate treatment of pneumonia caused by multidrug resistant gram-negative bacteria (MDR-GNB) but must be weighed against a higher risk of nephrotoxicity. Continuous veno-venous hemofiltration (CVVH) clears COL by filtering and membrane adsorption that permits to avoid dose accumulation and excessively high peak concentrations. We evaluated clinical/microbiological efficacy of the high-dose COL treatment under CVVH in patients with newly diagnosed MDR-GNB ventilator-associated pneumonia (VAP).
METHODS
METHODS
Observational cohort study in critically ill adult patients with MDR-GNB VAP. Colistimethate sodium (CMS) was administered as a 9 million international units (MIU) of loading dose followed by 3 × 4.5 MIU daily. CVVH was performed over a highly adsorptive membrane. Clinical and microbiological efficacies were assessed at the end of therapy. In survivors, serum creatinine level was evaluated before and at the end of therapy.
RESULTS
RESULTS
Fourteen patients (8 male patients, aged 57 ± 14 years) were consecutively included. Isolated pathogens were
CONCLUSIONS
CONCLUSIONS
In patients with MDR-GNB VAP, CVVH may represent an interesting option to enable effective high-dose COL treatment.
Identifiants
pubmed: 31637180
doi: 10.2478/jtim-2019-0022
pii: jtim-2019-0022
pmc: PMC6795054
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100-105Informations de copyright
© 2019 Herbert Spapen, Johan van Laethem, Maya Hites, An Verdoodt, Marc Diltoer, Patrick M. Honoré, published by Sciendo.
Déclaration de conflit d'intérêts
Conflict of Interest There is no competing interest related to the article.
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