Treatment of Ventilator-associated Pneumonia with High-dose Colistin Under Continuous Veno-venous Hemofiltration

Herbert Spapen; Johan van Laethem; Maya Hites; An Verdoodt; Marc Diltoer; Patrick M Honoré

doi:10.2478/jtim-2019-0022

Treatment of Ventilator-associated Pneumonia with High-dose Colistin Under Continuous Veno-venous Hemofiltration

J Transl Int Med. 2019 Oct 12;7(3):100-105. doi: 10.2478/jtim-2019-0022. eCollection 2019 Sep.

Authors

Herbert Spapen¹, Johan van Laethem², Maya Hites³, An Verdoodt¹, Marc Diltoer¹, Patrick M Honoré⁴

Affiliations

¹ Intensive Care Department, University Hospital, Vrije Universiteit Brussels, Brussels, Belgium.
² Department of Internal Medicine, University Hospital, Vrije Universiteit Brussels, Brussels, Belgium.
³ Department of Infectious Disease, Erasme Hospital, Brussels, Belgium.
⁴ Intensive Care Department, Centre Hospitalier Universitaire Brugmann/Brugmann University Hospital, Brussels, Belgium.

Abstract

Background and objectives: High-dose colistin (COL) ensures adequate treatment of pneumonia caused by multidrug resistant gram-negative bacteria (MDR-GNB) but must be weighed against a higher risk of nephrotoxicity. Continuous veno-venous hemofiltration (CVVH) clears COL by filtering and membrane adsorption that permits to avoid dose accumulation and excessively high peak concentrations. We evaluated clinical/microbiological efficacy of the high-dose COL treatment under CVVH in patients with newly diagnosed MDR-GNB ventilator-associated pneumonia (VAP).

Methods: Observational cohort study in critically ill adult patients with MDR-GNB VAP. Colistimethate sodium (CMS) was administered as a 9 million international units (MIU) of loading dose followed by 3 × 4.5 MIU daily. CVVH was performed over a highly adsorptive membrane. Clinical and microbiological efficacies were assessed at the end of therapy. In survivors, serum creatinine level was evaluated before and at the end of therapy.

Results: Fourteen patients (8 male patients, aged 57 ± 14 years) were consecutively included. Isolated pathogens were Pseudomonas aeruginosa in 7, Klebsiella pneumoniae in 5, and other Enterobacteriaceae in 2 patients. A favorable clinical response was observed in 9 patients (64%). Full and presumed microbiological eradication was observed in 12 patients (86%). Two patients were diagnosed with Stage 1 acute kidney injury.

Conclusions: In patients with MDR-GNB VAP, CVVH may represent an interesting option to enable effective high-dose COL treatment.

Keywords: acute kidney injury; colistin; continuous veno-venous hemofiltration; nephrotoxicity; ventilator-associated pneumonia.