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Successful Colistin Treatment of Multidrug-Resistant Pseudomonas aeruginosa Infection Using a Rapid Method for Determination of Colistin in Plasma: Usefulness of Therapeutic Drug Monitoring

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タイトル: Successful Colistin Treatment of Multidrug-Resistant Pseudomonas aeruginosa Infection Using a Rapid Method for Determination of Colistin in Plasma: Usefulness of Therapeutic Drug Monitoring
著者: Yamada, Takehiro 著作を一覧する
Ishiguro, Nobuhisa 著作を一覧する
Oku, Kenji 著作を一覧する
Higuchi, Issei 著作を一覧する
Nakagawa, Ikuma 著作を一覧する
Noguchi, Atsushi 著作を一覧する
Yasuda, Shinsuke 著作を一覧する
Fukumoto, Tatsuya 著作を一覧する
Iwasaki, Sumio 著作を一覧する
Akizawa, Kouji 著作を一覧する
Furugen, Ayako 著作を一覧する
Yamaguchi, Hiroaki 著作を一覧する
Iseki, Ken 著作を一覧する
キーワード: colistin
drug monitoring
multidrug-resistant Pseudomonas aeruginosa
発行日: 2015年 9月
出版者: The Pharmaceutical Society of Japan (日本薬学会)
誌名: Biological & pharmaceutical bulletin
巻: 38
号: 9
開始ページ: 1430
終了ページ: 1433
抄録: A 56-year-old woman with systemic lupus erythematosus had bacteremia due to multidrug-resistant Pseudomonas aeruginosa (MDRP). She was initially treated with imipenem cilastatin, tobramycin, and aztreonam; however, MDRP was still detected intermittently in her plasma. Multidrug-susceptibility tests demonstrated that MDRP was susceptible only to colistin. Therefore, in addition to these antibiotics, the administration of intravenous colistin methanesulfonate, a prodrug formula of colistin, was started at a daily dose of 2.5 mg/kg (as colistin base activity). The initial dose setting was based on the patient's renal function (baseline creatinine clearance=32.7mL/min). After initiating colistin, the patient's C-reactive protein levels gradually decreased. Blood cultures showed no evidence of MDRP on days 8, 14, and 22 after colistin initiation. However, the patient's renal function went from bad to worse owing to septic shock induced by methicillin-resistant Staphylococcus aureus (MRSA) infection. A few days later, the trough plasma levels of colistin were 7.88 mg/L, which appeared to be higher than expected. After decreasing the colistin dose, the patient's renal function gradually improved. On the final day of colistin treatment, the plasma levels decreased to 0.60 mg/L. MDRP could not be detected in blood culture after colistin treatment. Therefore, we successfully treated a case of bloodstream infection due to MDRP by therapeutic drug monitoring (TDM) of colistin. It is suggested that the monitoring of blood colistin levels by liquid chromatography-tandem mass spectrometry can contribute to safer, more effective antimicrobial therapy of MDRP because TDM facilitates quick decisions on dose adjustments.
資料タイプ: article
URI: http://hdl.handle.net/2115/60203
出現コレクション:雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

提供者: 山田 武宏

 

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