| Title: | Successful Colistin Treatment of Multidrug-Resistant Pseudomonas aeruginosa Infection Using a Rapid Method for Determination of Colistin in Plasma: Usefulness of Therapeutic Drug Monitoring |
| Authors: | Yamada, Takehiro Browse this author |
| Ishiguro, Nobuhisa Browse this author →KAKEN DB |
| Oku, Kenji Browse this author |
| Higuchi, Issei Browse this author |
| Nakagawa, Ikuma Browse this author |
| Noguchi, Atsushi Browse this author |
| Yasuda, Shinsuke Browse this author →KAKEN DB |
| Fukumoto, Tatsuya Browse this author |
| Iwasaki, Sumio Browse this author |
| Akizawa, Kouji Browse this author |
| Furugen, Ayako Browse this author |
| Yamaguchi, Hiroaki Browse this author →KAKEN DB |
| Iseki, Ken Browse this author →KAKEN DB |
| Keywords: | colistin |
| drug monitoring |
| multidrug-resistant Pseudomonas aeruginosa |
| Issue Date: | Sep-2015 |
| Publisher: | The Pharmaceutical Society of Japan |
| Journal Title: | Biological & pharmaceutical bulletin |
| Volume: | 38 |
| Issue: | 9 |
| Start Page: | 1430 |
| End Page: | 1433 |
| Publisher DOI: | 10.1248/bpb.b15-00323 |
| Abstract: | 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. |
| Type: | article |
| URI: | http://hdl.handle.net/2115/60203 |
| Appears in Collections: | 北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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