colistin and Apnea

We describe a 51-year-old man who developed renal and neural toxicity after the administration of colistin. He developed respiratory apnoea, neuromuscular blockade and severe comatose encephalopathy with the lack of brainstem reflexes. After discontinuation of the antibiotic, he made a prompt recovery to his baseline neurological function. The case illustrates the importance of recognising the toxicities associated with colistin. Although recent literature details its nephrotoxicity, current data have been discordant with the rare cases of respiratory apnoea or neuromuscular blockade once cited over 30 years ago. Additionally, no cases have ever described the profound encephalopathy with lack of brainstem function described here. The awareness of colistin's potentially fatal effects must be kept in mind when administering this antibiotic. Vigilance of the encephalopathic picture can also facilitate the diagnosis of colistin-mediated neurotoxicity in a patient with altered mental status of otherwise unknown aetiology.

Topics: Anti-Bacterial Agents; Apnea; Brain Stem; Colistin; Coma; Humans; Kidney Diseases; Male; Middle Aged; Neuromuscular Diseases; Neurotoxicity Syndromes

Topics: Administration, Intravenous; Aged; Anti-Bacterial Agents; Apnea; Aztreonam; Colistin; Drug Resistance, Multiple, Bacterial; Fatal Outcome; Humans; Male; Pseudomonas aeruginosa; Pseudomonas Infections; Respiratory Paralysis

There has been a resurgence of interest in the use of colistin for the treatment of multidrug-resistant Gram-negative bacterial infections. A more favorable infection outcome is observed when colistin is used in combination with carbapenems. We present a patient with severe New Delhi metallo-β-lactamase-1 Escherichia coli infection who developed convulsions rapidly followed by acute respiratory muscle weakness and apnoea during treatment with colistin and meropenem. Chromatographic assay showed a "trough" colistin level that was approximately fourfold higher than previously reported maximum steady-state colistin plasma levels in critically ill patients. The patient's renal clearance never necessitated dose adjustments, suggesting that the observed high plasma colistin level might be due to impaired non renal elimination. Although meropenem itself has very low neurotoxic potential, its concomitant use with colistin may have elicited colistin neurotoxicity.

Topics: Anti-Bacterial Agents; Apnea; beta-Lactamases; Chromatography; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Humans; Male; Meropenem; Middle Aged; Plasma; Seizures; Thienamycins

Topics: Acute Kidney Injury; Adult; Apnea; Colistin; Humans; Male; Neurologic Manifestations

Topics: Acute Kidney Injury; Adolescent; Adult; Age Factors; Aged; Apnea; Body Weight; Colistin; Drug Hypersensitivity; Female; Follow-Up Studies; Humans; Kidney Diseases; Kidney Function Tests; Male; Middle Aged; Nausea; Nervous System Diseases; Paresthesia; Pneumonia; Prospective Studies; Pyelonephritis; Respiratory Insufficiency; Sepsis; Sex Factors; Statistics as Topic; Time Factors; Vomiting

Topics: Aged; Apnea; Colistin; Drug Synergism; Female; Humans; Male; Middle Aged; Neuromuscular Nondepolarizing Agents; Postoperative Complications

Topics: Apnea; Colistin; Female; Humans; Middle Aged

Topics: Apnea; Calcium Chloride; Colistin; Female; Humans; Kidney Calculi; Middle Aged; Paralysis; Postoperative Complications; Preanesthetic Medication; Ureteral Calculi

Topics: Aged; Apnea; Colistin; Female; Humans; Polymyxins; Pyelonephritis

Topics: Apnea; Colistin; Dexamethasone; Escherichia coli Infections; Femoral Fractures; Fractures, Spontaneous; Hydrocortisone; Injections; Injections, Intramuscular; Osteomyelitis; Spinal Injuries; Tetracycline; Toxicology