Colistin Pharmacokinetics in Burn Patients During Continuous Venovenous Hemofiltration
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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While colistin is considered a last resort for the treatment of multidrug-resistant Gram-negative bacterial infections, there has been an increase in its use due to the increasing prevalence of drug-resistant infections worldwide. The pharmacology of colistin is complex, and pharmacokinetic data are limited, especially in patients requiring renal replacement therapy. As a result, dosing for patients who require renal replacement remains a challenge. Here, we present pharmacokinetic data for colistin from two burn patients 37 and 68 years old infected with colistin-susceptible isoclonal Acinetobacter baumannii and receiving continuous venovenous hemofiltration CVVH. To our knowledge, we are the first to examine data from before and during CVVH for one patient, allowing analysis of the effect of CVVH on colistin pharmacokinetics. Pharmacokineticpharmacodynamic analysis indicated that a dose increase from 1.5 to 2.2 mgkg of body weight colistin base activity on CVVH was insufficient to satisfy the target parameter of an AUC24MIC area under the concentration-time curve over 24 h in the steady state divided by the MIC of 60 at an MIC of1 mugml in one patient with residual endogenous renal function. Plasma concentrations of colistin ranged from 0 to 15 mugml, with free colistin levels ranging from 0.4 to 2.2 mugml. While both patients resolved their clinical infections and survived to discharge, colistin-resistant colonizing isolates resulted from therapy in one patient. The variabilities observed in colistin concentrations and pharmacokinetic characteristics highlight the importance of pharmacokinetic monitoring of antibiotics in patients undergoing renal replacement therapy.
- Medicine and Medical Research