Changes of colistin pharmacokinetics in critically ill patients due to the extracorporeal membrane oxygenation: Results of the COL-ECMO2022 trial
| Autoři | |
|---|---|
| Rok publikování | 2025 |
| Druh | Článek v odborném periodiku |
| Časopis / Zdroj | International Journal of Antimicrobial Agents |
| Fakulta / Pracoviště MU | |
| Citace | |
| www | https://www.sciencedirect.com/science/article/pii/S0924857925001372?via%3Dihub |
| Doi | https://doi.org/10.1016/j.ijantimicag.2025.107582 |
| Klíčová slova | Colistin; Critically ill; Pharmacokinetics; Extracorporeal membrane oxygenation; Investigator-initiated study |
| Popis | Introduction: Colistin is recognized as the last-resort antibiotic for treating infections caused by multidrug-resistant Gram-negative bacteria, especially in critically ill patients. However, its interference with the extracorporeal membrane oxygenation (ECMO) circuit may affect the achievement of therapeutic targets. The COL-ECMO2022 study aimed to verify the interference of colistin and its prodrug colistimethanesulphonate (CMS) with ECMO. Methods: A prospective pharmacokinetic phase IV study included critically ill adults in whom the parenteral colistin was part of standard medical care. A maximum of three dosing intervals were monitored for each patient. CMS and colistin concentrations were measured by HPLC-MS. ECMO and non-ECMO patients were compared by average steady-state colistin concentration (CAVG,SS ), population pharmacokinetic model (ECMO as a covariate), and linear mixed-effect model (LMEM). Results: Eighteen patients and 40 monitored dosing intervals were analyzed. Median CAVG,SS was nonsignificantly lower in 7 patients on ECMO (4.3 [3.5-6.3] mg/L) than in 11 non-ECMO patients (5.2 [4.2- 11.5] mg/L) (by 18%; P = 0.551). ECMO was not a significant covariate for any pharmacokinetic parameter in the population PK model. Although LMEM proved significant adsorption of CMS on the ECMO circuit, colistin concentrations were not significantly influenced. Conclusion: No significant differences in colistin plasma concentrations were detected; therefore, CMS dosage adjustment is unnecessary in patients on ECMO. (c) 2025 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights are reserved, including those for text and data mining, AI training, and similar technologies. |
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