Successful colistin treatment of multidrug-resistant pseudomonas aeruginosa infection using a rapid method for determination of colistin in plasma: Usefulness of therapeutic drug monitoring

Takehiro Yamada, Nobuhisa Ishiguro, Kenji Oku, Issei Higuchi, Ikuma Nakagawa, Atsushi Noguchi, Shinsuke Yasuda, Tatsuya Fukumoto, Sumio Iwasaki, Kouji Akizawa, Ayako Furugen, Hiroaki Yamaguchi, Ken Iseki

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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=32.7 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.

Original languageEnglish
Pages (from-to)1430-1433
Number of pages4
JournalBiological and Pharmaceutical Bulletin
Volume38
Issue number9
DOIs
Publication statusPublished - 2015 Sep 1

Keywords

  • Colistin
  • Drug monitoring
  • Multidrug-resistant Pseudomonas aeruginosa

ASJC Scopus subject areas

  • Pharmacology
  • Pharmaceutical Science

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  • Cite this

    Yamada, T., Ishiguro, N., Oku, K., Higuchi, I., Nakagawa, I., Noguchi, A., Yasuda, S., Fukumoto, T., Iwasaki, S., Akizawa, K., Furugen, A., Yamaguchi, H., & Iseki, K. (2015). Successful colistin treatment of multidrug-resistant pseudomonas aeruginosa infection using a rapid method for determination of colistin in plasma: Usefulness of therapeutic drug monitoring. Biological and Pharmaceutical Bulletin, 38(9), 1430-1433. https://doi.org/10.1248/bpb.b15-00323