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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  • Yamada Takehiro
    Department of Pharmacy, Hokkaido University Hospital Infection Control Team, Hokkaido University
  • Ishiguro Nobuhisa
    Infection Control Team, Hokkaido University
  • Oku Kenji
    Division of Rheumatology, Endocrinology, and Nephrology, Hokkaido University Graduate School of Medicine
  • Higuchi Issei
    Department of Pharmacy, Hokkaido University Hospital
  • Nakagawa Ikuma
    Division of Rheumatology, Endocrinology, and Nephrology, Hokkaido University Graduate School of Medicine
  • Noguchi Atsushi
    Division of Rheumatology, Endocrinology, and Nephrology, Hokkaido University Graduate School of Medicine
  • Yasuda Shinsuke
    Division of Rheumatology, Endocrinology, and Nephrology, Hokkaido University Graduate School of Medicine
  • Fukumoto Tatsuya
    Infection Control Team, Hokkaido University
  • Iwasaki Sumio
    Infection Control Team, Hokkaido University
  • Akizawa Kouji
    Department of Pharmacy, Hokkaido University Hospital
  • Furugen Ayako
    Department of Pharmacy, Hokkaido University Hospital
  • Yamaguchi Hiroaki
    Department of Pharmacy, Hokkaido University Hospital
  • Iseki Ken
    Department of Pharmacy, Hokkaido University Hospital Laboratory of Clinical Pharmaceutics and Therapeutics, Division of Pharmasciences, Faculty of Pharmaceutical Sciences, Hokkaido University

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タイトル別名
  • Successful Colistin Treatment of Multidrug-Resistant <i>Pseudomonas aeruginosa</i> Infection Using a Rapid Method for Determination of Colistin in Plasma: Usefulness of Therapeutic Drug Monitoring

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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=32.7 mL/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.

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