Treatment of ventilator-associated pneumonia with high-dose colistin under continuous veno-venous hemofiltration

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 VAR Colistimethate sodium (CMS) was administered as a 9 million international units (MIU) of loading dose followed by 3 x 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, Klebsiefia pneumoniae in 5, and other Enterobactedaceae 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.