Sorlí Luisa, Luque Sonia, Segura Concepción, Campillo Nuria, Montero Milagro, Esteve Erika, Herrera Sabina, Benito Natividad, Alvarez-Lerma Francisco, Grau Santiago, Horcajada Juan Pablo
Infectious Disease Service, Hospital del Mar, Barcelona, Spain.
Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
BMC Infect Dis. 2017 Jan 5;17(1):11. doi: 10.1186/s12879-016-2117-7.
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.
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 (C) were recorded. The primary and secondary end points were clinical cure and 30-day all-cause mortality.
Ninety-one patients were included. Clinical cure was observed in 72 (79%) patients. The mean (SD) C 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).
In this series of patients with infections caused by XDR P. aeruginosa infections, C is not observed to be related to clinical outcome.
黏菌素的治疗窗较窄，肾毒性是主要的剂量限制性不良反应。目前，最佳剂量和治疗性血浆水平尚不清楚。
前瞻性观察队列研究，纳入接受静脉注射多黏菌素甲磺酸钠（CMS）治疗的对黏菌素敏感的铜绿假单胞菌感染患者。记录临床数据和稳态时的黏菌素血浆水平（C）。主要和次要终点分别为临床治愈和30天全因死亡率。
纳入91例患者。72例（79%）患者实现临床治愈。临床治愈患者和未治愈患者的平均（标准差）C分别为1.49（1.4）mg/L和2.42（1.5）mg/L（p = 0.01）。临床失败的独立危险因素为男性（比值比5.88；95%置信区间1.09 - 31.63））、急性生理与慢性健康状况评分系统II（APACHE II）评分（比值比1.15；95%置信区间1.03 - 1.27）和治疗结束时的肾毒性（比值比9.13；95%置信区间2.06 - 40.5）。30天死亡率为30.8%。30天死亡率的危险因素包括APACHE II评分（比值比1.98；95%置信区间1.20）、麦凯布评分（比值比2.49；95%置信区间1.14 - 5.43）和治疗结束时（EOT）存在肾毒性（比值比3.8；95%置信区间1.26 - 11.47）。
在这组由广泛耐药铜绿假单胞菌感染引起感染的患者中，未观察到C与临床结局相关。
