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Prospective Observational Study for Impact of Plasma Levels of Colistin in Patients with Carbapenem Resistant Acinetobacter Baumannii Infection
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A2627 - Prospective Observational Study for Impact of Plasma Levels of Colistin in Patients with Carbapenem Resistant Acinetobacter Baumannii Infection
Author Block: Y. Jeong1, N. Gu2, W. Kwack3, Y. Kang4, S. Park3, J. Oh3, Y. Yoon3; 1Internal Medicine, Dongguk University Ilsan Hospital, Go-yang City, Korea, Republic of, 2Clinical Pharmacology and Therapeutics, Dongguk University Ilsan Hospital, Go-yang city, Korea, Republic of, 3Internal Medicine, Dongguk University Ilsan Hospital, Go-yang city, Korea, Republic of, 4Internal Medicine, Samsung Changwon Hospital, Changwon, Korea, Republic of.
Introduction The emergence of carbapenem Resistant Acinetobacter baumannii (CRAB) Infection has increased the use of colisitn which has a narrow therapeutic window with nephrotoxicity. Little is known about optimal therapeutic plasma concentration. We conducted this study to identify the adequate range of therapeutic concentration to reduce nephrotoxicity in treating CRAB-infected patients with colistin. Methods A prospective cohort study was performed in one teaching hospital from May 2015 to July 2017. The patients with CRAB infection were treated with colistin methanesulfonate (CMS) IV, 2.5~5mg/kg/day. Plasma colistin and CMS concentrations were measured at the 3rd and 4th day of treatment using High performance liquid chromatography (HPLC) methods. Results Twenty patients were included. All patients were diagnosed with hospital- acquired pneumonia with CRAB. The median age was 80 years old. Sixteen patients were male. Nephrotoxicity was developed in 6 (30.0%) patients and all patients were recovered completely. At steady state, the mean (SD) plasma level of CMS after 4.5hours after administration on 4th day was 6.39 (2.99) mg/L and 2.77 (1.04) mg/L (p=0.004) in patients who had nephrotoxicity or not, respectively. The mean (SD) plasma level of colistin after 4.5hours after administration on 4th day was 4.24 (2.19) mg/L and 2.27 (1.05) mg/L (p=0.017) in patients who had nephrotoxicity or not, respectively. Baseline GFR was not different among both groups, 93.3 vs. 92.5ml/min/1.73m2 (p=0.710). Clinical cure or improvement was observed in 7 (35.0%) patients. Bacteriologic improvement was observed in 15 (75.0%) patients respectively. There was no difference in peak or trough plasma level of among patients with clinical or bacterial improvement. Conclusion This preliminary study has confirmed CMS plasma level was important in developing nephrotoxicity. Further large study for optimal therapeutic plasma levels of CMS and colistin was mandatory.
Author Block: Y. Jeong1, N. Gu2, W. Kwack3, Y. Kang4, S. Park3, J. Oh3, Y. Yoon3; 1Internal Medicine, Dongguk University Ilsan Hospital, Go-yang City, Korea, Republic of, 2Clinical Pharmacology and Therapeutics, Dongguk University Ilsan Hospital, Go-yang city, Korea, Republic of, 3Internal Medicine, Dongguk University Ilsan Hospital, Go-yang city, Korea, Republic of, 4Internal Medicine, Samsung Changwon Hospital, Changwon, Korea, Republic of.
Introduction The emergence of carbapenem Resistant Acinetobacter baumannii (CRAB) Infection has increased the use of colisitn which has a narrow therapeutic window with nephrotoxicity. Little is known about optimal therapeutic plasma concentration. We conducted this study to identify the adequate range of therapeutic concentration to reduce nephrotoxicity in treating CRAB-infected patients with colistin. Methods A prospective cohort study was performed in one teaching hospital from May 2015 to July 2017. The patients with CRAB infection were treated with colistin methanesulfonate (CMS) IV, 2.5~5mg/kg/day. Plasma colistin and CMS concentrations were measured at the 3rd and 4th day of treatment using High performance liquid chromatography (HPLC) methods. Results Twenty patients were included. All patients were diagnosed with hospital- acquired pneumonia with CRAB. The median age was 80 years old. Sixteen patients were male. Nephrotoxicity was developed in 6 (30.0%) patients and all patients were recovered completely. At steady state, the mean (SD) plasma level of CMS after 4.5hours after administration on 4th day was 6.39 (2.99) mg/L and 2.77 (1.04) mg/L (p=0.004) in patients who had nephrotoxicity or not, respectively. The mean (SD) plasma level of colistin after 4.5hours after administration on 4th day was 4.24 (2.19) mg/L and 2.27 (1.05) mg/L (p=0.017) in patients who had nephrotoxicity or not, respectively. Baseline GFR was not different among both groups, 93.3 vs. 92.5ml/min/1.73m2 (p=0.710). Clinical cure or improvement was observed in 7 (35.0%) patients. Bacteriologic improvement was observed in 15 (75.0%) patients respectively. There was no difference in peak or trough plasma level of among patients with clinical or bacterial improvement. Conclusion This preliminary study has confirmed CMS plasma level was important in developing nephrotoxicity. Further large study for optimal therapeutic plasma levels of CMS and colistin was mandatory.
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