colistin and Diabetes-Mellitus

Topics: Adolescent; Adrenergic beta-Agonists; Adult; Advance Care Planning; Anti-Bacterial Agents; Anti-Inflammatory Agents; Bone Density; Bronchodilator Agents; Career Choice; Child; Colistin; Cystic Fibrosis; Diabetes Complications; Diabetes Mellitus; Education; Employment; Energy Intake; Exercise; Expectorants; Family Planning Services; Gastrointestinal Diseases; Humans; Insurance, Disability; Liver Diseases; Nutritional Support; Oxygen Inhalation Therapy; Palliative Care; Patient Care Team; Physical Fitness; Respiration, Artificial; United States

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteremia; Child; Child, Preschool; Colistin; Diabetes Complications; Diabetes Mellitus; Drug Resistance, Bacterial; Female; Hospitalization; Humans; Infant; Infant, Newborn; Intensive Care Units; Lebanon; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Minocycline; Mortality; Prevalence; Respiration, Artificial; Retrospective Studies; Risk Factors; Shock, Septic; Steroids; Tigecycline; Treatment Outcome; Young Adult

Patients with cystic fibrosis (CF) are at high risk from the nephrotoxic effects of intravenous antibiotics due to repeated and prolonged courses of therapy. Routine methods of monitoring renal injury are insensitive. N-acetyl-b-d-glucosaminidase (NAG) is a lysosomal enzyme present in the renal proximal tubular cells, with increased excretion an indicator of renal tubular dysfunction.. Urinary NAG, creatinine, serum creatinine, electrolytes and BUN were measured on days 1, 14 and at the first out-patient visit following treatment with tobramycin or colistin. Urinary NAG levels were corrected for urinary creatinine and expressed as a NAG ratio. Patients who received>1 course of intravenous antibiotics during the study period were included in a separate analysis of the cumulative effect of treatment.. 88 patients (44 female, 31 with CFRD) completed a single course of intravenous antibiotics. 71 patients had urinary NAG levels at follow-up. The median time to follow-up was 50 days. Serum electrolytes, creatinine and BUN were normal throughout. A 3.5-fold increase in urinary NAG excretion was observed between day 1 and 14 and 46% of patients had an elevated NAG level at follow-up. A highly significant difference in NAG excretion was observed on day 14 for tobramycin vs. colistin (median 2.24 vs. 0.98, p<0.001). A significant difference in NAG excretion was seen in patients with CFRD at all measured time points. Patients with CFRD had a significantly worse clinical status and had received more days of intravenous antibiotics over the previous 6 years. In 20 (80%) of 25 patients who received>1 course of treatment during the study period, baseline NAG levels were significantly higher in subsequent courses (p<0.001). There was a significant correlation between previous exposure to colistin and baseline NAG levels (r=0.389, p<0.001).. Both tobramycin and colistin cause acute renal tubular injury with a significant rise in urinary NAG excretion. Patients with CFRD seem to be at greatest risk of renal tubular damage. Cumulative damage is evident with repeated dosing. Previous exposure to nephrotoxic antibiotics, especially colistin, is associated with elevated baseline NAG levels. We recommend that colistin is reserved for patients with resistant Pseudomonas aeruginosa or those who are intolerant to tobramycin. Serial longitudinal NAG measurements may be useful in patients with CF, especially those with CFRD, to identify patients at risk of developing renal disease.

Topics: Acetylglucosaminidase; Adolescent; Adult; Anti-Bacterial Agents; Colistin; Creatinine; Cystic Fibrosis; Diabetes Mellitus; Female; Humans; Kidney Tubules; Kidney Tubules, Proximal; Male; Prospective Studies; Tobramycin

Multidrug-resistant infections present a serious clinical and therapeutical problem. Colistin is an old-used polymyxin with rather poor pharmacokinetic profile and a remarkable nephrotoxicity. However, the emergence of multidrug-resistant bacteria has recently led to the increased use of colistin as a potentially available therapy. This article presents a 75-year-old diabetic woman with an early onset total knee arthroplasty infection by a multidrug-resistant Pseudomonas aeruginosa bacterial isolate that was managed successfully with surgical removal of the knee prosthesis, antibiotic impregnated cement and intravenous administration of colistin for 6 weeks, and second stage revision knee surgery. Two years later, laboratory and imaging studies showed no evidence of recurrence of infection.

Topics: Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Bone Cements; Colistin; Comorbidity; Diabetes Mellitus; Drug Resistance, Multiple, Bacterial; Female; Femoral Fractures; Humans; Knee Prosthesis; Prosthesis-Related Infections; Pseudomonas Infections; Reoperation

Opportunistic infections of the external auditory canal or the middle ear due to Pseudomonas aeruginosa occurring in patients with low resistance to infection have a 35 percent mortality rate. Once the process extends into the pneumatized temporal bone, eradication becomes more difficult and the mortality rate increases to 72 percent because of the high incidence of involvement of cranial nerves, adjacent intracranial vessels, and meningitis. Treatment is directed towards the underlying condition, administration of systemic carbenicillin and gentamicin, topical colistin therapy, and judicious surgical debridement. Pseudomonas vaccine may be of help. Fifteen cases are presented. Nine follow the pattern of malignant external otitis and six began as a primary acute otitis media.

Topics: Adult; Aged; Carbenicillin; Colistin; Diabetes Mellitus; Female; Gentamicins; Humans; Infant; Male; Mastoiditis; Middle Aged; Otitis Externa; Otitis Media; Pseudomonas aeruginosa; Pseudomonas Infections

Topics: Alcaligenes; Anti-Bacterial Agents; Chloramphenicol; Colistin; Diabetes Mellitus; Enterobacteriaceae; Escherichia coli Infections; Female; Humans; Kanamycin; Klebsiella; Neomycin; Nitrofurantoin; Novobiocin; Penicillins; Polymyxins; Proteus Infections; Staphylococcal Infections; Streptomycin; Sulfonamides; Tetracycline; Urinary Tract Infections