Abstract
Polymyxins are ‘‘old’’ antimicrobials which were abandoned for almost 30 years because of significant renal and neurological toxicity. However, the alarming rise of multi-resistant Gramnegative bacterial infections worldwide has revived interest in these ‘‘forgotten’’ agents. Colistin (polymyxin E) is one of the main antibiotics of this class. It is most often administered as the pro-drug colistimethate sodium. Doses for treatment of systemic infections in adults range between 3 and 9 million IU per day. Colistin is increasingly used for treatment of pneumonia and bacteremia in critically ill patients. During their ICU stay, many of these subjects will need continuous renal replacement therapy (CRRT) because of acute kidney injury or an unstable hemodynamic condition. Based on recent pharmacological data and own experience, we postulate that patients undergoing CRRT may receive substantially higher doses of colistin (i.e., a high loading dose, followed by a maintenance dose up to 4.5 million IU tid). Treatment can be continued for a prolonged time period without increasing toxicity. CRRT counteracts colistin accumulation because the drug is continuously filtered and also significantly adsorbed in the bulk of the dialysis membrane. Implementing such ‘‘CRRT rescue’’ therapy does require the strict use of highly adsorptive dialysis membranes in association with citrate anticoagulation to increase membrane performance.
References
1. Spapen HD, Jacobs R, Van Gorp V, Troubleyn J, Honoré PM. Renal and neurological side effects of colistin in critically ill patients. Ann Intensive Care 2011;1:14.10.1186/2110-5820-1-14Search in Google Scholar
2. Bergen PJ, Li J, Rayner CR, Nation RL. Colistin methanesulfonate is an inactive prodrug of colistin against Pseudomonas aeruginosa.Antimicrob Agents Chemother 2006;50:1953-8.10.1128/AAC.00035-06Search in Google Scholar
3. Couet W, Grégoire N, Marchand S, Mimoz O. Colistin pharmacokinetics: The fog is lifting. Clin Microbiol Infect 2012;18:30-9.10.1111/j.1469-0691.2011.03667.xSearch in Google Scholar
4. Yahav D, Farbman L, Leibovici L, Paul M. Colistin: New lessons on an old antibiotic. Clin Microbiol Infect 2012;18:18-29.10.1111/j.1469-0691.2011.03734.xSearch in Google Scholar
5. Deryke CA, Crawford AJ, Uddin N, Wallace MR. Colistin dosing and nephrotoxicity in a large community teaching hospital. Antimicrob Agents Chemother 2010;54:4503-5.10.1128/AAC.01707-09Search in Google Scholar
6. Hartzell JD, Neff R, Ake J, Howard R, Olson S, Paolino K, et al.Nephrotoxicity associated with intravenous colistin (colistimethate sodium) treatment at a tertiary care medical center. Clin Infect Dis 2009;48:1724-8.10.1086/599225Search in Google Scholar
7. Michalopoulos AS, Falagas ME. Colistin: Recent data on pharmacodynamics properties and clinical efficacy in critically ill patients. Ann Intensive Care 2011;1:30.10.1186/2110-5820-1-30Search in Google Scholar
8. Spapen HD, Honore PM, Gregoire N, Gobin P, de Regt J, Martens GA, et al. Convulsions and apnoea in a patient infected with New Delhi metallo-β-lactamase-1 Escherichia coli treated with colistin. J Infect 2011;63:468-70.10.1016/j.jinf.2011.07.008Search in Google Scholar
9. Li J, Nation RL, Turnidge JD, Milne RW, Coulthard K, Rayner CR, et al. Colistin: The re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections. Lancet Infect Dis 2006;6:589-601.10.1016/S1473-3099(06)70580-1Search in Google Scholar
10. Mohamed AF, Karaiskos I, Plachouras D, Karvanen M, Pontikis K, Jansson B, et al. Application of a loading dose of colistin methanesulfonate in critically ill patients: Population pharmacokinetics, protein binding, and prediction of bacterial kill. Antimicrob Agents Chemother 2012;56:4241-9.10.1128/AAC.06426-11Search in Google Scholar PubMed PubMed Central
11. Marchand S, Frat JP, Petitpas F, Lemaître F, Gobin P, Robert R, et al. Removal of colistin during intermittent haemodialysis in two critically ill patients. J Antimicrob Chemother 2010;65:1836-7.10.1093/jac/dkq185Search in Google Scholar PubMed
12. Markou N, Fousteri M, Markantonis SL, Zidianakis B, Hroni D, Boutzouka E, et al. Colistin pharmacokinetics in intensive care unit patients on continuous venovenous haemodiafiltration: An observational study. J Antimicrob Chemother 2012;67:2459-62.10.1093/jac/dks257Search in Google Scholar PubMed
13. Cho YS, Yim H, Yang HT, Hur J, Chun W, Kim JH, et al. Use of parenteral colistin for the treatment of multiresistant Gram-negative organisms in major burn patients in South Korea. Infection 2012;40:27-33.10.1007/s15010-011-0192-7Search in Google Scholar PubMed
14. Li J, Rayner CR, Nation RL, Deans R, Boots R, Widdecombe N, et al. Pharmacokinetics of colistin methanesulfonate and colistin in a critically ill patient receiving continuous venovenous hemodiafiltration. Antimicrob Agents Chemother 2005;49:4814-5.10.1128/AAC.49.11.4814-4815.2005Search in Google Scholar PubMed PubMed Central
15. Plachouras D, Karvanen M, Friberg LE, Papadomichelakis E, Antoniadou A, Tsangaris I, et al. Population pharmacokinetic analysis of colistin methanesulfonate and colistin after intravenous administration in critically ill patients with infections caused by gram-negative bacteria. Antimicrob Agents Chemother 2009;53:3430-6.10.1128/AAC.01361-08Search in Google Scholar PubMed PubMed Central
16. Honore PM, Jacobs R, Lochy S, De Waele E, Van Gorp V, De Regt J, et al. Acute respiratory muscle weakness and apnea in a critically ill patient induced by colistin neurotoxicity: Key potential role of hemoadsorption elimination during continuous venovenous hemofiltration. Int J Nephrol Renovasc Dis 2013;6:107-11.10.2147/IJNRD.S42791Search in Google Scholar PubMed PubMed Central
17. Lee J, Han S, Jeon S, Hong T, Song W, Woo H, et al. Population pharmacokinetic analysis of colistin in burn patients. Antimicrob Agents Chemother 2013;57:2141-6.10.1128/AAC.00271-13Search in Google Scholar PubMed PubMed Central
18. Honore PM, Jacobs R, Joannes-Boyau O, De Regt J, De Waele E, van Gorp V, et al. Newly designed CRRT membranes for sepsis and SIRS-a pragmatic approach for bedside intensivists summarizing the more recent advances: A systematic structured review. ASAIO J 2013;59:99-106.10.1097/MAT.0b013e3182816a75Search in Google Scholar PubMed
19. Morimatsu H, Uchino S, Bellomo R, Ronco C. Continuous renal replacement therapy: Does technique influence electrolyte and bicarbonate control? Int J Artif Organs 2003;4:289-96.Search in Google Scholar
20. Joannes-Boyau O, Honoré PM, Perez P, Bagshaw SM, Grand H, Canivet JL, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): A multicentre randomized controlled trial. Intensive Care Med 2013;39:1535-46.10.1007/s00134-013-2967-zSearch in Google Scholar PubMed
21. Zhang P, Yang Y, Lv R, Zhang Y, Xie W, Chen J, et al. Effect of the intensity of continuous renal replacement therapy in patients with sepsis and acute kidney injury: A single-center randomized clinical trial. Nephrol Dial Transplant 2012;27:967-73.10.1093/ndt/gfr486Search in Google Scholar PubMed
22. Kellum JA, Lameire N, For the KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: A KDIGO summary (Part 1). Crit Care 2013;17: R204.10.1186/cc11454Search in Google Scholar PubMed PubMed Central
23. Honore PM, Joannes-Boyau O, Collin V, Boer W, Gressens B, Janvier G. Practical daily management of extra-renal continuous removal. Reanimation 2008;17:472-8.10.1016/j.reaurg.2008.04.008Search in Google Scholar
24. Hofbauer R, Moser D, Frass M, Oberbauer R, Kaye AD, Wagner O, et al. Effect of anticoagulation on blood membrane interactions during hemodialysis. Kidney Int 1999;56:1578-83.10.1046/j.1523-1755.1999.00671.xSearch in Google Scholar PubMed
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