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Valiyakath Hydross M, Abdul Samad S, Balakrishna Savitri M, Datt Upadhyay A. Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study. JoMMID 2024; 12 (1) :50-58
URL: http://jommid.pasteur.ac.ir/article-1-612-en.html
Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study
Mohammed Valiyakath Hydross , Sameer Abdul Samad * , Mahesh Balakrishna Savitri , Ashish Datt Upadhyay
2Department of Infectious Diseases, Aster Malabar Institute of Medical Sciences, Calicut, Kerala, India; NHS Dumfries and Galloway Royal Infirmary, Scotland, United Kingdom
Abstract:   (910 Views)
Introduction: Colistin, a polymyxin antibiotic often reserved for treatment of multidrug-resistant Gram-negative infections, exhibits a narrow therapeutic index. Careful consideration of the pharmacokinetic (PK) and pharmacodynamic (PD) parameters of colistin is essential to maximize its efficacy and minimize toxicity. Both thrice-daily and twice-daily administration regimens have been employed, with critically ill patients posing unique challenges regarding colistin's PK/PD. Methods: This retrospective observational study compared the mortality rates, cure rates, length of hospital stay, nephrotoxicity, and readmission rates associated with thrice-daily and twice-daily administration of a fixed total daily dose of 9 million international units (MIU) of colistin in 151 critically ill patients with multidrug-resistant Gram-negative infections. Propensity score matching with a 1:5 case-control ratio was performed using XLSTAT software (by Addinsoft), and outcomes were analysed using logistic regression analysis. Results: Thrice-daily dosing of colistin was recorded in 125 patients, and twice-daily dosing in 26 patients. A total of 73 patients were included in the final analysis after propensity score matching. The 28-day mortality rates, clinical cure rates, and microbiological failure rates were comparable between the two groups (Odds ratio (OR) [95% confidence-interval (CI)] = 0.48 [0.07-3.46], P=0.467; 1.67 [0.31-8.90], P=0.548; 0.13 [0.001-19.5], P = 0.428, respectively). Hospital readmission rates within 90 days (OR [95% CI] = 1.05 [0.12-9.10], P=0.964) and duration of hospital stay (Beta coefficient = 1.55, P=0.683) were also comparable between the two groups. The incidence of nephrotoxicity-related AKI events during Colistin therapy was significantly lower with the 4.5 MIU twice-daily regimen (OR [95% CI] = 0.04 [0.004-0.35], P=0.004). Conclusion: Twice-daily colistin administration significantly reduces the risk of nephrotoxicity-related AKI events compared to thrice-daily administration in critically ill patients with multidrug-resistant Gram-negative infections.
Keywords: Multi-drug resistant Gram-negative infections, Colistin, Dosage regimen, Nephrotoxicity, Acute kidney injury (AKI) events
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Type of Study: Original article | Subject: Anti-microbial agents, resistance and treatment protocols
Received: 2023/10/24 | Accepted: 2024/05/21 | Published: 2024/06/8
References
1. who.int [internet]. WHO: AWaRe classification of antibiotics for evaluation and monitoring of use, 2023 [cited 2024 March 32]. Available from: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.04
2. icmr.nic.in [internet]. Annual report 2021: Antimicrobial Resistance Research and Surveillance Network [cited 2024 March 24]. Available from: Annual Report 2021: Antimicrobial Resistance Research and Surveillance Network (icmr.nic.in)
3. Tsuji BT, Pogue JM, Zavascki AP, Paul M, Daikos GL, Forrest A, et al. International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). Pharmacotherapy. 2019; 39 (1): 10-39. [DOI:10.1002/phar.2209] [PMID] []
4. Labuschagne Q, Schellack N, Gous A, Bronkhorst E, Schellack G, Tonder L van, et al. COLISTIN: adult and paediatric guideline for South Africa, 2016. S Afr J Infect Dis. 2016; 31 (1): 3-7. [DOI:10.4102/sajid.v31i1.95]
5. Nation RL, Garonzik SM, Thamlikitkul V, Giamarellos-Bourboulis EJ, Forrest A, Paterson DL, et al. Dosing Guidance for Intravenous Colistin in Critically Ill Patients. Clin. Infect. Dis. 2017; 64 (5): 565-71. [DOI:10.1093/cid/ciw839] [PMID] []
6. kdigo.org [internet]. Acute Kidney Injury (AKI) - KDIGO. [cited 2023 May 28]. Available from: https://kdigo.org/guidelines/acute-kidney-injury/
7. clsi.org [internet]. M100Ed33 | Performance Standards for Antimicrobial Susceptibility Testing, 33rd Edition. [cited 2023 Jun 17]. Available from: https://clsi.org/standards/products/microbiology/documents/m100/
8. Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections. Clin Infect Dis. 2023; ciad428. [DOI:10.1093/cid/ciad428] [PMID]
9. Dalfino L, Puntillo F, Mosca A, Monno R, Spada ML, Coppolecchia S, et al. High-Dose, Extended-Interval Colistin Administration in Critically Ill Patients: Is This the Right Dosing Strategy? A Preliminary Study. Clin Infect Dis. 2012; 54 (12): 1720. [DOI:10.1093/cid/cis286] [PMID] []
10. Akajagbor DS, Wilson SL, Shere-Wolfe KD, Dakum P, Charurat ME, Gilliam BL. Higher incidence of acute kidney injury with intravenous colistimethate sodium compared with polymyxin B in critically ill patients at a tertiary care medical center. Clin Infect Dis. 2013; 57 (9): 1300-3. [DOI:10.1093/cid/cit453] [PMID]
11. Ghazaeian M, Mokhtari M, Kouchek M, Miri M, Goharani R, Ghodssi-Ghassemabadi R, et al. Once Versus Thrice Daily Colistin in Critically Ill Ptients with Multi-Drug Resistant Infections. Iran J Pharm Res. 2017; 16 (3): 1247.
12. Plachouras D, Karvanen M, Friberg LE, Papadomichelakis E, Antoniadou A, Tsangaris I, et al. Population pharmacokinetic analysis of colistin methanesulfonate and colistin after intravenous administration in critically ill patients with infections caused by gram-negative bacteria. Antimicrob Agents Chemother. 2009; 53 (8): 3430-6. [DOI:10.1128/AAC.01361-08] [PMID] []
13. Markou N, Markantonis SL, Dimitrakis E, Panidis D, Boutzouka E, Karatzas S, et al. Colistin serum concentrations after intravenous administration in critically ill patients with serious multidrug-resistant, gram-negative bacilli infections: A prospective, open-label, uncontrolled study. Clin Ther. 2008; 30 (1): 143-51. [DOI:10.1016/j.clinthera.2008.01.015] [PMID]
14. Poudyal A, Howden BP, Bell JM, Gao W, Owen RJ, Turnidge JD, et al. In vitro pharmacodynamics of colistin against multidrug-resistant Klebsiella pneumoniae. J Antimicrob Chemother. 2008; 62 (6): 1311-8. [DOI:10.1093/jac/dkn425] [PMID]
15. Owen RJ, Li J, Nation RL, Spelman D. In vitro pharmacodynamics of colistin against Acinetobacter baumannii clinical isolates. J Antimicrob Chemother. 2007; 59 (3): 473-7. [DOI:10.1093/jac/dkl512] [PMID]
16. Ghlissi Z, Hakim A, Mnif H, Ayadi FM, Zeghal K, Rebai T, et al. Evaluation of colistin nephrotoxicity administered at different doses in the rat model. Ren Fail. 2013; 35 (8): 1130-5. [DOI:10.3109/0886022X.2013.815091] [PMID]
17. Prasannan B, Mukthar F, Unni V, Mohan S, Vinodkumar K. Colistin Nephrotoxicity-Age and Baseline kidney Functions Hold the Key. Indian J Nephrol. 2021; 31 (5): 449. [DOI:10.4103/ijn.IJN_130_20] [PMID] []
18. Samarkos M, Papanikolaou K, Sourdi A, Paisios N, Mainas E, Paramythiotou E, Antoniadou A, Sambatakou H, Gargalianos-Kakolyris P, Skoutelis A, Daikos GL. The Effect of Different Colistin Dosing Regimens on Nephrotoxicity: A Cohort Study. Antibiotics. 2022; 11 (8): 1066. [DOI:10.3390/antibiotics11081066] [PMID] []
19. Miano TA, Lautenbach E, Wilson FP, Guo W, Borovskiy Y, Hennessy S. Attributable risk and time course of colistin-associated acute kidney injury. Clin. J. Am. Soc. Nephrol. 2018; 13 (4): 542-50. [DOI:10.2215/CJN.06980717] [PMID] []
20. Rabi R, Enaya A, Sweileh MW, Aiesh BM, Namrouti A, Hamdan ZI, et al. Comprehensive Assessment of Colistin Induced Nephrotoxicity: Incidence, Risk Factors and Time Course. Infect Drug Resist. 2023; 16: 3007-17. [DOI:10.2147/IDR.S409964] [PMID] []
21. Plachouras D, Karvanen M, Friberg LE, Papadomichelakis E, Antoniadou A, Tsangaris I, et al. Population pharmacokinetic analysis of colistin methanesulfonate and colistin after intravenous administration in critically ill patients with infections caused by gram-negative bacteria. Antimicrob Agents Chemother. 2009; 53 (8): 3430-6. [DOI:10.1128/AAC.01361-08] [PMID] []
22. Couet W, Grégoire N, Gobin P, Saulnier PJ, Frasca D, Marchand S, et al. Pharmacokinetics of colistin and colistimethate sodium after a single 80-mg intravenous dose of CMS in young healthy volunteers. Clin Pharmacol Ther. 2011; 89 (6): 875-9. [DOI:10.1038/clpt.2011.48] [PMID]
23. Shields RK, Anand R, Clarke LG, Paronish JA, Weirich M, Perone H, et al. Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria. PLoS One. 2017; 12 (3): e0173286. [DOI:10.1371/journal.pone.0173286] [PMID] []
24. Rigatto MH, Oliveira MS, Perdigão-Neto L V., Levin AS, Carrilho CM, Tanita MT, et al. Multicenter Prospective Cohort Study of Renal Failure in Patients Treated with Colistin versus Polymyxin B. Antimicrob Agents Chemother. 2016; 60 (4): 2443-9. [DOI:10.1128/AAC.02634-15] [PMID] []
25. Rattanaumpawan P, Ungprasert P, Thamlikitkul V. Risk factors for colistin-associated nephrotoxicity. J Infect. 2011; 62 (2): 187-90. [DOI:10.1016/j.jinf.2010.11.013] [PMID]
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.