Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study
Introduction: Colistin, a polymyxin antibiotic often reserved for treatment of multidrug-resistant Gram-negative infections, exhibits a narrow therapeutic index. Careful consideration of the pharmacokinetic (PK) and pharmacodynamic (PD) parameters of colistin is essential to maximize its efficac...
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Pasteur Institute of Iran
2024-03-01
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| Series: | Journal of Medical Microbiology and Infectious Diseases |
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| author | Mohammed Valiyakath Hydross1 Sameer Abdul Samad2, 5* Mahesh Balakrishna Savitri3 Ashish Datt Upadhyay4 |
| author_facet | Mohammed Valiyakath Hydross1 Sameer Abdul Samad2, 5* Mahesh Balakrishna Savitri3 Ashish Datt Upadhyay4 |
| author_sort | Mohammed Valiyakath Hydross1 |
| collection | DOAJ |
| description | Introduction: Colistin, a polymyxin antibiotic often reserved for treatment
of multidrug-resistant Gram-negative infections, exhibits a narrow
therapeutic index. Careful consideration of the pharmacokinetic (PK) and
pharmacodynamic (PD) parameters of colistin is essential to maximize its
efficacy and minimize toxicity. Both thrice-daily and twice-daily
administration regimens have been employed, with critically ill patients
posing unique challenges regarding colistin's PK/PD. Methods: This
retrospective observational study compared the mortality rates, cure rates,
length of hospital stay, nephrotoxicity, and readmission rates associated with
thrice-daily and twice-daily administration of a fixed total daily dose of 9
million international units (MIU) of colistin in 151 critically ill patients with
multidrug-resistant Gram-negative infections. Propensity score matching
with a 1:5 case-control ratio was performed using XLSTAT software (by
Addinsoft), and outcomes were analysed using logistic regression analysis.
Results: Thrice-daily dosing of colistin was recorded in 125 patients, and
twice-daily dosing in 26 patients. A total of 73 patients were included in the
final analysis after propensity score matching. The 28-day mortality rates,
clinical cure rates, and microbiological failure rates were comparable
between the two groups (Odds ratio (OR) [95% confidence-interval (CI)] =
0.48 [0.07-3.46], P=0.467; 1.67 [0.31-8.90], P=0.548; 0.13 [0.001-19.5], P
= 0.428, respectively). Hospital readmission rates within 90 days (OR [95%
CI] = 1.05 [0.12-9.10], P=0.964) and duration of hospital stay (Beta
coefficient = 1.55, P=0.683) were also comparable between the two groups.
The incidence of nephrotoxicity-related AKI events during Colistin therapy
was significantly lower with the 4.5 MIU twice-daily regimen (OR [95% CI]
= 0.04 [0.004-0.35], P=0.004). Conclusion: Twice-daily colistin
administration significantly reduces the risk of nephrotoxicity-related AKI
events compared to thrice-daily administration in critically ill patients with
multidrug-resistant Gram-negative infections. |
| format | Article |
| id | doaj-art-a2a0049bce4e4c8a8ccd789f2ca69c06 |
| institution | Kabale University |
| issn | 2345-5349 2345-5330 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | Pasteur Institute of Iran |
| record_format | Article |
| series | Journal of Medical Microbiology and Infectious Diseases |
| spelling | doaj-art-a2a0049bce4e4c8a8ccd789f2ca69c062025-08-20T03:52:52ZengPasteur Institute of IranJournal of Medical Microbiology and Infectious Diseases2345-53492345-53302024-03-01121505810.61186/JoMMID.12.1.50Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational StudyMohammed Valiyakath Hydross10https://orcid.org/0000-0002-7836-1872Sameer Abdul Samad2, 5*1https://orcid.org/0000-0001-7521-938XMahesh Balakrishna Savitri32Ashish Datt Upadhyay43https://orcid.org/0000-0002-5957-54291Department of Clinical Pharmacy, Aster Malabar Institute of Medical Sciences, Calicut, Kerala, India2Department of Infectious Diseases, Aster Malabar Institute of Medical Sciences, Calicut, Kerala, India; 5NHS Dumfries and Galloway Royal Infirmary, Scotland, United Kingdom3Department of Critical Care, Aster Malabar Institute of Medical Sciences, Calicut, Kerala, India4Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, IndiaIntroduction: Colistin, a polymyxin antibiotic often reserved for treatment of multidrug-resistant Gram-negative infections, exhibits a narrow therapeutic index. Careful consideration of the pharmacokinetic (PK) and pharmacodynamic (PD) parameters of colistin is essential to maximize its efficacy and minimize toxicity. Both thrice-daily and twice-daily administration regimens have been employed, with critically ill patients posing unique challenges regarding colistin's PK/PD. Methods: This retrospective observational study compared the mortality rates, cure rates, length of hospital stay, nephrotoxicity, and readmission rates associated with thrice-daily and twice-daily administration of a fixed total daily dose of 9 million international units (MIU) of colistin in 151 critically ill patients with multidrug-resistant Gram-negative infections. Propensity score matching with a 1:5 case-control ratio was performed using XLSTAT software (by Addinsoft), and outcomes were analysed using logistic regression analysis. Results: Thrice-daily dosing of colistin was recorded in 125 patients, and twice-daily dosing in 26 patients. A total of 73 patients were included in the final analysis after propensity score matching. The 28-day mortality rates, clinical cure rates, and microbiological failure rates were comparable between the two groups (Odds ratio (OR) [95% confidence-interval (CI)] = 0.48 [0.07-3.46], P=0.467; 1.67 [0.31-8.90], P=0.548; 0.13 [0.001-19.5], P = 0.428, respectively). Hospital readmission rates within 90 days (OR [95% CI] = 1.05 [0.12-9.10], P=0.964) and duration of hospital stay (Beta coefficient = 1.55, P=0.683) were also comparable between the two groups. The incidence of nephrotoxicity-related AKI events during Colistin therapy was significantly lower with the 4.5 MIU twice-daily regimen (OR [95% CI] = 0.04 [0.004-0.35], P=0.004). Conclusion: Twice-daily colistin administration significantly reduces the risk of nephrotoxicity-related AKI events compared to thrice-daily administration in critically ill patients with multidrug-resistant Gram-negative infections.multi-drug resistant gramnegative infectionscolistindosage regimennephrotoxicityacute kidney injury (aki) events |
| spellingShingle | Mohammed Valiyakath Hydross1 Sameer Abdul Samad2, 5* Mahesh Balakrishna Savitri3 Ashish Datt Upadhyay4 Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study Journal of Medical Microbiology and Infectious Diseases multi-drug resistant gramnegative infections colistin dosage regimen nephrotoxicity acute kidney injury (aki) events |
| title | Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study |
| title_full | Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study |
| title_fullStr | Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study |
| title_full_unstemmed | Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study |
| title_short | Comparative Efficacy of Twice and Thrice Daily Colistin Administration in Critically Ill Patients Battling Multi-Drug Resistant Gram-Negative Infections: An Observational Study |
| title_sort | comparative efficacy of twice and thrice daily colistin administration in critically ill patients battling multi drug resistant gram negative infections an observational study |
| topic | multi-drug resistant gramnegative infections colistin dosage regimen nephrotoxicity acute kidney injury (aki) events |
| work_keys_str_mv | AT mohammedvaliyakathhydross1 comparativeefficacyoftwiceandthricedailycolistinadministrationincriticallyillpatientsbattlingmultidrugresistantgramnegativeinfectionsanobservationalstudy AT sameerabdulsamad25 comparativeefficacyoftwiceandthricedailycolistinadministrationincriticallyillpatientsbattlingmultidrugresistantgramnegativeinfectionsanobservationalstudy AT maheshbalakrishnasavitri3 comparativeefficacyoftwiceandthricedailycolistinadministrationincriticallyillpatientsbattlingmultidrugresistantgramnegativeinfectionsanobservationalstudy AT ashishdattupadhyay4 comparativeefficacyoftwiceandthricedailycolistinadministrationincriticallyillpatientsbattlingmultidrugresistantgramnegativeinfectionsanobservationalstudy |