Results: Total 34 patients enrolled. Median duration of CCT was 10 days with 61% of patients achieved the target colistin level without any difference between the 2 groups. Imipenem combination therapy had a trend to produce the highest microbiological success rates (6/8 patients, 75%) compared with others. All bacteremic and urinary-tract-infection patients had 100% microbiological success while others did not (p-value <0.0001). There was no significant correlation between treatment outcome, colistin levels, and acute kidney injury (AKI). Prevalence of AKI was 10 folds higher among individuals with age >65 years old (95% CI, 1.05-95.23) and 1.625 folds greater when GFR <60 ml/min (95% CI, 1.19-2.20). Higher APACHE II scores predicted higher mortality (p-value=0.031).
Conclusion: Firstly, current recommended dosing regimen may not be a consensus in such clinical setting; secondly, plasma colistin level may not be a good indicator for assessing treatment efficacy both in terms of overall clinical response and microbiological success; thirdly, synergistic effect from an appropriate partner antimicrobial agent maybe another consideration in choosing a CCT formulation to ensure optimal clinical response and potentially a lower dosage of colistin; fourthly, CCT is not efficacious equally for all sites of bacterial infection, and lastly APACHE score is still the key determining mortality outcome regardless of treatment regimen.
P. Bunupuradah, None
S. Auparakkitanon, None
J. Krongvorakul, None
J. Sueajai, None