Evaluation of the Efficacy of Colistin Therapy with or without Loading Dose in the Treatment of Multi Drug Resistant Gram-negative Bacterial Infections

Öz

Aim: Colistin (Col) is an agent used in the treatment of multidrug-resistant gram-negative (MDRGN) bacterial infections. This drug has been administered with a loading dose in recent years to provide rapid clinical response and therapeutic blood levels. In our study, we aimed to evaluate whether there is a relationship between the efficacy of the loading dose of Col treatment, mortality, microbiological clearance during treatment, nephrotoxicity, and neurotoxicity side effects for the treatment of MDRGN bacterial infections. Material method: In this retrospective study, which included a control group, 6-years data was analyzed. Totally, 323 patients who received Col treatment with or without loading dose (LD) were included in the study. Patients were divided into two groups; I: without Col-LD regimen (those who were hospitalized in 2011-2014), II: with Col-LD regimen (those who were hospitalized in 2015-2017). Demographic characteristics such as age, gender, microbiological cultures, laboratory results, side effects, and mortality of the patients were evaluated. Results: A statistically significant relationship was found between with Col-LD regimen and nephrotoxicity. However, it was determined that there was no statistically significant relationship between microbiological clearance without a Col-LD regimen. Nephrotoxicity was found to be decreased with the Col-LD regimen. Neurotoxicity was observed more frequently (3.7%) in with Col-LD regimen. Initial and final C-reactive protein (CRP) and procalcitonin (PCT) levels were statistically significantly lower in with Col-LD regimen. Conclusion: It was found that with Col-LD regimen had a statistically significant effect on nephrotoxicity, neurotoxicity, and treatment outcome, but had no effect on microbiological clearance. In addition, with Col-LD regimen was effective in decreasing CRP and PCT values.

Anahtar Kelimeler

• Colistin
• colistin loading therapy
• multiple resistant
• gram negative bacterial infection

Çoklu İlaca Dirençli Gram-negatif Bakteriyel Enfeksiyonların Tedavisinde Yükleme Dozlu veya Yüklemesiz Kolistin Tedavisinin Etkinliğinin Değerlendirilmesi

Öz

Amaç: Kolistin (Col), çok ilaca dirençli gram-negatif (MDRGN) bakteriyel enfeksiyonların tedavisinde kullanılan bir ajandır. Bu ilaç hızlı klinik yanıt ve terapötik kan seviyeleri sağlamak için son yıllarda yükleme dozu ile uygulanmaktadır. Çalışmamızda MDRGN bakteriyel enfeksiyonlarının tedavisinde Col tedavisinin yükleme dozunun etkinliği ile mortalite, tedavi sırasındaki mikrobiyolojik klirens, nefrotoksisite ve nörotoksisite yan etkileri arasında bir ilişki olup olmadığını değerlendirmeyi amaçladık. Gereç yöntem: Kontrol grubu içeren bu retrospektif çalışmada 6 yıllık veriler analiz edildi. Toplamda yükleme dozu (LD) olan veya olmayan Col tedavisi alan 323 hasta çalışmaya dahil edildi. Hastalar iki gruba ayrıldı; I: Col-LD rejimi almayanlar (2011-2014'te hastaneye yatırılanlar), II: Col-LD rejimi uygulananlar (2015-2017'de hastaneye yatırılanlar). Hastaların yaş, cinsiyet, mikrobiyolojik kültürler, laboratuvar sonuçları, yan etkiler ve mortalite gibi demografik özellikleri değerlendirildi. Bulgular: Col-LD rejimi ile nefrotoksisite arasında istatistiksel olarak anlamlı bir ilişki bulundu. Ancak Col-LD rejimi olmadan mikrobiyolojik klirens arasında istatistiksel olarak anlamlı bir ilişki olmadığı belirlendi. Col-LD rejimi ile nefrotoksisitenin azaldığı bulundu. Nörotoksisite, Col-LD rejiminde daha sık (%3.7) gözlendi. İlk ve son C-reaktif protein (CRP) ve prokalsitonin (PCT) seviyeleri Col-LD rejiminde istatistiksel olarak anlamlı derecede düşüktü. Sonuç: Col-LD rejiminin nefrotoksisite, nörotoksisite ve tedavi sonucu üzerinde istatistiksel olarak anlamlı bir etkiye sahip olduğu, ancak mikrobiyolojik klirens üzerinde hiçbir etkisinin olmadığı bulundu. Ayrıca Col-LD rejimi ile CRP ve PCT değerlerinin düşürülmesinde etkili olmuştur.

Anahtar Kelimeler

• Kolistin
• kolistin yükleme tedavisi
• çoklu dirençli
• gram negatif bakteriyel enfeksiyon

Kaynakça

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