Once Versus Thrice Daily Colistin in Critically Ill Ptients with Multi-Drug Resistant Infections

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Pharmacology

Background:

• Multi-drug resistant (MDR) gram-negative infections pose a significant threat in intensive care units (ICUs).
• Colistin is a crucial antibiotic for treating these infections, but optimal dosing strategies are still debated.
• Procalcitonin (PCT) is a biomarker used to monitor bacterial infections and response to antibiotic therapy.

Purpose of the Study:

• To compare procalcitonin (PCT) changes in patients with MDR gram-negative infections treated with two different high-dose colistin regimens.
• To evaluate the impact of these regimens on clinical outcomes, including ICU length of stay (LOS) and mortality.

Main Methods:

• A prospective study involving adult ICU patients with bacteremia or ventilator-associated pneumonia (VAP) caused by MDR gram-negative pathogens.
• Patients were randomized into two groups: Group A received 9 million international units (MIU) of colistin every 24 hours, and Group B received 3 MIU every 8 hours.
• PCT levels were measured at baseline, day 3, and day 5. ICU LOS and mortality were recorded.

Main Results:

• A total of 34 patients completed the study; 30 had VAP and 4 had bacteremia.
• No statistically significant differences were observed in baseline characteristics between the groups.
• Mean PCT levels, ICU LOS, and ICU mortality showed no significant differences between the colistin regimens (P > 0.05 for all).

Conclusions:

• High-dose colistin administration, whether every 8 or 24 hours, did not result in statistically significant differences in serum PCT levels, ICU LOS, or ICU mortality.
• These findings suggest that both dosing intervals may be comparable in managing severe MDR gram-negative infections in the ICU setting.