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2017 ; 10
(ä): 293-298
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Clinical outcomes and nephrotoxicity of colistin loading dose for treatment of
extensively drug-resistant Acinetobacter baumannii in cancer patients
#MMPMID28919792
Katip W
; Uitrakul S
; Oberdorfer P
Infect Drug Resist
2017[]; 10
(ä): 293-298
PMID28919792
show ga
BACKGROUND: Colistin is a last-line defense therapy against extensively
drug-resistant Acinetobacter baumannii (XDR-AB). Despite a loading dose of
colistin being applied in many clinical practices, studies evaluating the effect
of the loading dose of colistin in cancer patients remain limited. PATIENTS AND
METHODS: A retrospective cohort study of cancer patients who received either a
loading or non-loading dose of colistin for treatment of XDR-AB was conducted.
For each group, the clinical response, bacteriological eradication and serum
creatinine were recorded. Logistic regression was applied to evaluate the effects
of therapy on each of the three aforementioned outcomes. RESULTS: One hundred and
two patients diagnosed with XDR-AB infections between January 2012 and December
2015 were recruited. Only 75 patients were given a loading dose of colistin.
There was no significant clinical and microbiological response in patients in the
loading dose group or patients in the non-loading dose group. However, 38
(50.67%) patients in the loading dose group and 6 (22.22%) patients in the
non-loading dose group developed nephrotoxicity according to the RIFLE criteria
(p = 0.013). Multivariate logistic regression analysis showed that independent
predictors of clinical response were Charlson score ?4 and duration of colistin
treatment ?10 days. Septic shock correlated with both poor clinical and
microbiological response. Independent predictors for nephrotoxicity were loading
dose colistin and patient's age ?60 years. CONCLUSION: Administration of colistin
loading dose did not significantly increase clinical response, microbiological
response or mortality rate compared to non-loading dose in cancer patients with
XDR-AB-related infections. However, nephrotoxicity was significantly higher when
patients received loading dose colistin.