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Üçüncü basamak bir hastanede COVID-19 tanılı hastalarda remdesivir deneyimi

Year 2023, Volume: 16 Issue: 1, 1 - 7, 31.01.2023
https://doi.org/10.31362/patd.1102822

Abstract

Amaç: Remdesivir, COVID-19 tedavi kombinasyonlarında önerilen bir adenozin nükleotid analogu antiviral bir ilaçtır. COVID-19 tedavisinde aşı ve ilaç çalışmaları devam ederken, remdesivir de etkinlik, güvenlik ve olası yan etkiler açısından incelenmektedir. Bu nedenle hastanemizde COVID-19 tanısı alan ve remdesivir ile tedavi edilen hastalarımızın deneyimlerimizi paylaşmayı amaçladık.
Gereç ve yöntem: 15 Mart-30 Mart 2020 tarihleri arasında, hastanemize başvuran ve nazofarengeal örneklerden çalışılan RT-PCR testi pozitif olan ve/veya toraks bilgisayarlı tomografi (BT) sonuçlarına göre COVID-19 tanısı alan 18 yaş üstü hastalar retrospektif olarak tarandı. Remdesivir tedavisi alanlar çalışmamıza dahil edildi.
Bulgular: Çalışmamıza 23 hasta dahil edildi. Hastaların 18'i (%79,2) erkek, 5'i (%20,8) kadındı. Remdesivir başlama süresi semptomların başlangıcından itibaren 8,4±2,6 gün ve tanı anından itibaren 6±2,6 gündü. Takip döneminde 18 hastayı (%78,2) yoğun bakım ünitesine (YBÜ) yatırmak zorunda kaldık. 14'ünde (%60,8) mekanik ventilatöre ihtiyaç duydu. Tedavi sonrası takiplerinde ise 15 hastanın (%65,2) taburcu edildiği ve 8 hastanın (%34,8) ölümle sonuçlandığını gösterildi.
Sonuç: COVID-19 hastalığının patogenezinde virüsün replikasyonu kadar inflamasyon da önemli olduğundan remdesivirin diğer antiviral, antisitokin tedaviler ile kombine şekilde kullanımı ile etkinliğinde artış olabileceği ve bu konuda da yapılacak yeni çalışmalara ihtiyaç olduğu düşünülmüştür.

Supporting Institution

DESTEKLEYEN KURUM YOKTUR

References

  • 1. Haseeb A, Faidah HS, Alghamdi S, Alotaibi AF, Elrggal ME et al. A. Dose Optimization of Colistin: A Systematic Review. Antibiotics (Basel). 2021; Nov 26;10(12):1454. doi: 10.3390/antibiotics10121454.
  • 2.Nazer LH, Anabtawi N. Optimizing colistin dosing: Is a loading dose necessary?.Am J Health Syst Pharm. 2017 Jan 1;74(1):e9-e16. doi: 10.2146/ajhp150876.
  • 3.Vardakas KZ, Rellos K, Triarides NA, Falagas ME. Colistin loading dose: evaluation of the published pharmacokinetic and clinical data. Int J Antimicrob Agents. 2016 Nov;48(5):475-484. doi: 10.1016/j.ijantimicag.2016.08.009.
  • 4.Bellos I, Pergialiotis V, Frountzas M, Kontzoglou K, Daskalakis G, Perrea DN. Efficacy and safety of colistin loading dose: a meta-analysis. J Antimicrob Chemother. 2020 Jul 1;75(7):1689-98. doi: 10.1093/jac/dkaa064
  • 5.American Thoracic Society and Infectious Disease Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.
  • 6.Tsuji BT, Pogue JM, Zavascki AP, Paul M, Daikos GL, 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 Jan;39(1):10-39. doi: 10.1002/phar.2209.
  • 7.Elefritz JL, Bauer KA, Jones C, Mangino JE, Porter K, ET AL. Efficacy and Safety of a Colistin Loading Dose, High-Dose Maintenance Regimen in Critically Ill Patients With Multidrug-Resistant Gram-Negative Pneumonia. J Intensive Care Med. 2017 Sep;32(8):487-493. doi: 10.1177/0885066616646551.
  • 8.Jung S, Chung EK, Jun MS, Son ES, Rhie SJ. Differences in Colistin Administration and Bacterial and Treatment Outcomes in Critically Ill Patients. Sci Rep. 2019 Jun 19;9(1):8781. doi: 10.1038/s41598-019-44965-y.
  • 9.Katip W, Meechoui M, Thawornwittayakom P, Chinwong D, Oberdorfer P. Efficacy and Safety of High Loading Dose of Colistin in Multidrug-Resistant Acinetobacter baumannii: A Prospective Cohort Study. J Intensive Care Med. 2019 Nov-Dec;34(11-12):996-1002. doi: 10.1177/0885066617725694
  • 10.Katip W, Uitrakul S, Oberdorfer P. Clinical Efficacy and Nephrotoxicity of the Loading Dose Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii in Critically Ill Patients. Pharmaceutics. 2021 Dec 24;14(1):31. doi: 10.3390/pharmaceutics14010031
  • 11.Trifi A, Abdellatif S, Daly F, Mahjoub K, Nasri R, et al. Efficacy and Toxicity of High-Dose Colistin in Multidrug-Resistant Gram-Negative Bacilli Infections: A Comparative Study of a Matched Series. Chemotherapy. 2016;61(4):190-196. doi: 10.1159/000442786.
  • 12.Alp E, Eren E, Elay G, Cevahir F, Esmaoğlu A, Rello J. Efficacy of loading dose of colistin in Acinetobacter baumannii ventilator-associated pneumonia. Infez Med. 2017 Dec 1;25(4):311-319.
  • 13.Heffernan AJ, Sime FB, Lipman J, Dhanani J, Andrews K, et al. Intrapulmonary pharmacokinetics of antibiotics used to treat nosocomial pneumonia caused by Gram-negative bacilli: A systematic review. Int J Antimicrob Agents. 2019 Mar;53(3):234-245. doi: 10.1016/j.ijantimicag.2018.11.011.
  • 14.Junsu Choe, You Min Sohn, Suk Hyeon Jeong, Hyo Jung Park, Soo Jin Na, et al. Inhalation with intravenous loading dose of colistin in critically ill patients with pneumonia caused by carbapenem-resistant gram-negative bacteria Ther Adv Respir Dis. 2019 Jan-Dec; 13:1753466619885529. Published online 2019 Nov 4. doi: 10.1177/1753466619885529
  • 15.Garnacho-Montero J, Timsit JF. Managing Acinetobacter baumannii infections. Curr Opin Infect Dis. 2019 Feb;32(1):69-76. doi: 10.1097/QCO.0000000000000518
  • 16.Paul M, Daikos GL, Durante-Mangoni E, Yahav D, Carmeli Y, et al. Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial. Lancet Infect Dis. 2018 Apr;18(4):391-400. doi: 10.1016/S1473-3099(18)30099-9. Epub 2018 Feb 16.
  • 17.Nutman A, Lellouche J, Temkin E, Daikos G, Skiada A, et al. Colistin plus meropenem for carbapenem-resistant Gram-negative infections: in vitro synergism is not associated with better clinical outcomes. Clin Microbiol Infect. 2020 Sep;26(9):1185-1191. doi: 10.1016/j.cmi.2020.03.035. Epub 2020 Apr 3
  • 18.Katip W, Uitrakul S, Oberdorfer P. The effectiveness and nephrotoxicity of loading dose colistin combined with or without meropenem for the treatment of carbapenem-resistant A. baumannii. Int J Infect Dis. 2020 Aug;97:391-395. doi: 10.1016/j.ijid.2020.05.100.
  • 19.Katip W, Uitrakul S, Oberdorfer P. A Comparison of Colistin versus Colistin Plus Meropenem for the Treatment of Carbapenem-Resistant Acinetobacter baumannii in Critically Ill Patients: A Propensity Score-Matched Analysis. Antibiotics (Basel). 2020 Sep 28;9(10):647. doi: 10.3390/antibiotics9100647.
  • 20.Katip W, Uitrakul S, Oberdorfer P. Clinical outcomes and nephrotoxicity of colistin loading dose for treatment of extensively drug-resistant Acinetobacter baumannii in cancer patients. Infect Drug Resist. 2017 Sep 7;10:293-298. doi: 10.2147/IDR.S144314
  • 21.Lim, L. M. Ly, N., Anderson, D., Yang, J. C., Macander, L., et al. Resurgence of colistin: a review of resistance, toxicity, pharmacodynamics, and dosing. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2010; 30(12): 1279-1291.
  • 22.Eljaaly K, Bidell MR, Gandhi RG, Alshehri S, Enani MA, et al. Colistin Nephrotoxicity: Meta-Analysis of Randomized Controlled Trials. Open Forum Infect Dis. 2021 Jan 21;8(2):ofab026. doi: 10.1093/ofid/ofab026
  • 23.Benattar YD, Omar M, Zusman O, Yahav D, Zak-Doron Y, et al. The Effectiveness and Safety of High-Dose Colistin: Prospective Cohort Study. Clin Infect Dis. 2016 Dec 15;63(12):1605-1612. doi: 10.1093/cid/ciw684

Remdesivir experience in patients diagnosed with COVID-19 in a tertiary hospital

Year 2023, Volume: 16 Issue: 1, 1 - 7, 31.01.2023
https://doi.org/10.31362/patd.1102822

Abstract

Purpose: Remdesivir is an adenosine nucleotide analog antiviral drug recommended in these treatment combinations. While vaccine and drug studies are underway in the treatment of COVID-19, remdesivir is also being studied in terms of efficacy, safety, and potential side effects. Therefore, we aimed to share our experiences of patients who were diagnosed with COVID-19 and treated with remdesivir in our hospital.
Material method: Patients over 18 years of age, who were diagnosed with COVID-19 in our hospital between March 15 and March 30, 2020, based on positive RT-PCR and/or thoracic computed tomography (CT) results studied from nasopharyngeal samples, were screened retrospectively. Those who had received Remdesivir treatment were included in our study.
Results: 23 patients were included in our study. Eighteen (79.2%) of the patients were male and 5 (20.8%) were female. Remdesivir initiation time was 8.4±2.6 days from the onset of symptoms and 6±2.6 days from the time of diagnosis. In the follow-up period, we had to hospitalize 18 patients (78.2%) in the intensive care unit (ICU). 14 (60.8%) needed a mechanical ventilator. Post-treatment follow-up showed that 15 (65.2%) recovered, and 8 (34.8%) resulted in mortality.
Conclusion: Since inflammation is as critical as the replication of the virus in the pathogenesis of COVID-19 disease, the use of remdesivir in combination with other antiviral and anti-cytokine therapies may increase the effectiveness. We believe that we need new studies in this regard.

References

  • 1. Haseeb A, Faidah HS, Alghamdi S, Alotaibi AF, Elrggal ME et al. A. Dose Optimization of Colistin: A Systematic Review. Antibiotics (Basel). 2021; Nov 26;10(12):1454. doi: 10.3390/antibiotics10121454.
  • 2.Nazer LH, Anabtawi N. Optimizing colistin dosing: Is a loading dose necessary?.Am J Health Syst Pharm. 2017 Jan 1;74(1):e9-e16. doi: 10.2146/ajhp150876.
  • 3.Vardakas KZ, Rellos K, Triarides NA, Falagas ME. Colistin loading dose: evaluation of the published pharmacokinetic and clinical data. Int J Antimicrob Agents. 2016 Nov;48(5):475-484. doi: 10.1016/j.ijantimicag.2016.08.009.
  • 4.Bellos I, Pergialiotis V, Frountzas M, Kontzoglou K, Daskalakis G, Perrea DN. Efficacy and safety of colistin loading dose: a meta-analysis. J Antimicrob Chemother. 2020 Jul 1;75(7):1689-98. doi: 10.1093/jac/dkaa064
  • 5.American Thoracic Society and Infectious Disease Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.
  • 6.Tsuji BT, Pogue JM, Zavascki AP, Paul M, Daikos GL, 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 Jan;39(1):10-39. doi: 10.1002/phar.2209.
  • 7.Elefritz JL, Bauer KA, Jones C, Mangino JE, Porter K, ET AL. Efficacy and Safety of a Colistin Loading Dose, High-Dose Maintenance Regimen in Critically Ill Patients With Multidrug-Resistant Gram-Negative Pneumonia. J Intensive Care Med. 2017 Sep;32(8):487-493. doi: 10.1177/0885066616646551.
  • 8.Jung S, Chung EK, Jun MS, Son ES, Rhie SJ. Differences in Colistin Administration and Bacterial and Treatment Outcomes in Critically Ill Patients. Sci Rep. 2019 Jun 19;9(1):8781. doi: 10.1038/s41598-019-44965-y.
  • 9.Katip W, Meechoui M, Thawornwittayakom P, Chinwong D, Oberdorfer P. Efficacy and Safety of High Loading Dose of Colistin in Multidrug-Resistant Acinetobacter baumannii: A Prospective Cohort Study. J Intensive Care Med. 2019 Nov-Dec;34(11-12):996-1002. doi: 10.1177/0885066617725694
  • 10.Katip W, Uitrakul S, Oberdorfer P. Clinical Efficacy and Nephrotoxicity of the Loading Dose Colistin for the Treatment of Carbapenem-Resistant Acinetobacter baumannii in Critically Ill Patients. Pharmaceutics. 2021 Dec 24;14(1):31. doi: 10.3390/pharmaceutics14010031
  • 11.Trifi A, Abdellatif S, Daly F, Mahjoub K, Nasri R, et al. Efficacy and Toxicity of High-Dose Colistin in Multidrug-Resistant Gram-Negative Bacilli Infections: A Comparative Study of a Matched Series. Chemotherapy. 2016;61(4):190-196. doi: 10.1159/000442786.
  • 12.Alp E, Eren E, Elay G, Cevahir F, Esmaoğlu A, Rello J. Efficacy of loading dose of colistin in Acinetobacter baumannii ventilator-associated pneumonia. Infez Med. 2017 Dec 1;25(4):311-319.
  • 13.Heffernan AJ, Sime FB, Lipman J, Dhanani J, Andrews K, et al. Intrapulmonary pharmacokinetics of antibiotics used to treat nosocomial pneumonia caused by Gram-negative bacilli: A systematic review. Int J Antimicrob Agents. 2019 Mar;53(3):234-245. doi: 10.1016/j.ijantimicag.2018.11.011.
  • 14.Junsu Choe, You Min Sohn, Suk Hyeon Jeong, Hyo Jung Park, Soo Jin Na, et al. Inhalation with intravenous loading dose of colistin in critically ill patients with pneumonia caused by carbapenem-resistant gram-negative bacteria Ther Adv Respir Dis. 2019 Jan-Dec; 13:1753466619885529. Published online 2019 Nov 4. doi: 10.1177/1753466619885529
  • 15.Garnacho-Montero J, Timsit JF. Managing Acinetobacter baumannii infections. Curr Opin Infect Dis. 2019 Feb;32(1):69-76. doi: 10.1097/QCO.0000000000000518
  • 16.Paul M, Daikos GL, Durante-Mangoni E, Yahav D, Carmeli Y, et al. Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial. Lancet Infect Dis. 2018 Apr;18(4):391-400. doi: 10.1016/S1473-3099(18)30099-9. Epub 2018 Feb 16.
  • 17.Nutman A, Lellouche J, Temkin E, Daikos G, Skiada A, et al. Colistin plus meropenem for carbapenem-resistant Gram-negative infections: in vitro synergism is not associated with better clinical outcomes. Clin Microbiol Infect. 2020 Sep;26(9):1185-1191. doi: 10.1016/j.cmi.2020.03.035. Epub 2020 Apr 3
  • 18.Katip W, Uitrakul S, Oberdorfer P. The effectiveness and nephrotoxicity of loading dose colistin combined with or without meropenem for the treatment of carbapenem-resistant A. baumannii. Int J Infect Dis. 2020 Aug;97:391-395. doi: 10.1016/j.ijid.2020.05.100.
  • 19.Katip W, Uitrakul S, Oberdorfer P. A Comparison of Colistin versus Colistin Plus Meropenem for the Treatment of Carbapenem-Resistant Acinetobacter baumannii in Critically Ill Patients: A Propensity Score-Matched Analysis. Antibiotics (Basel). 2020 Sep 28;9(10):647. doi: 10.3390/antibiotics9100647.
  • 20.Katip W, Uitrakul S, Oberdorfer P. Clinical outcomes and nephrotoxicity of colistin loading dose for treatment of extensively drug-resistant Acinetobacter baumannii in cancer patients. Infect Drug Resist. 2017 Sep 7;10:293-298. doi: 10.2147/IDR.S144314
  • 21.Lim, L. M. Ly, N., Anderson, D., Yang, J. C., Macander, L., et al. Resurgence of colistin: a review of resistance, toxicity, pharmacodynamics, and dosing. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2010; 30(12): 1279-1291.
  • 22.Eljaaly K, Bidell MR, Gandhi RG, Alshehri S, Enani MA, et al. Colistin Nephrotoxicity: Meta-Analysis of Randomized Controlled Trials. Open Forum Infect Dis. 2021 Jan 21;8(2):ofab026. doi: 10.1093/ofid/ofab026
  • 23.Benattar YD, Omar M, Zusman O, Yahav D, Zak-Doron Y, et al. The Effectiveness and Safety of High-Dose Colistin: Prospective Cohort Study. Clin Infect Dis. 2016 Dec 15;63(12):1605-1612. doi: 10.1093/cid/ciw684
There are 23 citations in total.

Details

Primary Language English
Subjects Infectious Diseases
Journal Section Research Article
Authors

Ayşegül Seremet Keskin 0000-0002-9224-4699

Kübra Demir Önder 0000-0002-4164-5118

Filiz Kızılateş 0000-0002-8985-893X

Publication Date January 31, 2023
Submission Date April 13, 2022
Acceptance Date June 27, 2022
Published in Issue Year 2023 Volume: 16 Issue: 1

Cite

APA Seremet Keskin, A., Demir Önder, K., & Kızılateş, F. (2023). Remdesivir experience in patients diagnosed with COVID-19 in a tertiary hospital. Pamukkale Medical Journal, 16(1), 1-7. https://doi.org/10.31362/patd.1102822
AMA Seremet Keskin A, Demir Önder K, Kızılateş F. Remdesivir experience in patients diagnosed with COVID-19 in a tertiary hospital. Pam Med J. January 2023;16(1):1-7. doi:10.31362/patd.1102822
Chicago Seremet Keskin, Ayşegül, Kübra Demir Önder, and Filiz Kızılateş. “Remdesivir Experience in Patients Diagnosed With COVID-19 in a Tertiary Hospital”. Pamukkale Medical Journal 16, no. 1 (January 2023): 1-7. https://doi.org/10.31362/patd.1102822.
EndNote Seremet Keskin A, Demir Önder K, Kızılateş F (January 1, 2023) Remdesivir experience in patients diagnosed with COVID-19 in a tertiary hospital. Pamukkale Medical Journal 16 1 1–7.
IEEE A. Seremet Keskin, K. Demir Önder, and F. Kızılateş, “Remdesivir experience in patients diagnosed with COVID-19 in a tertiary hospital”, Pam Med J, vol. 16, no. 1, pp. 1–7, 2023, doi: 10.31362/patd.1102822.
ISNAD Seremet Keskin, Ayşegül et al. “Remdesivir Experience in Patients Diagnosed With COVID-19 in a Tertiary Hospital”. Pamukkale Medical Journal 16/1 (January 2023), 1-7. https://doi.org/10.31362/patd.1102822.
JAMA Seremet Keskin A, Demir Önder K, Kızılateş F. Remdesivir experience in patients diagnosed with COVID-19 in a tertiary hospital. Pam Med J. 2023;16:1–7.
MLA Seremet Keskin, Ayşegül et al. “Remdesivir Experience in Patients Diagnosed With COVID-19 in a Tertiary Hospital”. Pamukkale Medical Journal, vol. 16, no. 1, 2023, pp. 1-7, doi:10.31362/patd.1102822.
Vancouver Seremet Keskin A, Demir Önder K, Kızılateş F. Remdesivir experience in patients diagnosed with COVID-19 in a tertiary hospital. Pam Med J. 2023;16(1):1-7.

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