Colistin
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Renal failure and liver failure: case report An adult man [age not stated] developed renal failure and liver failure during treatment with colistin for XDR Acinetobacter baumannii and KPC-producing Klebsiella pneumonia. The man was admitted to the ICU for acute respiratory failure. Subsequently, he was diagnosed with H1N1 influenza virus, which was complicated by bilateral pneumonia. He was intubated and shifted to another hospital. He was started on extracorporeal membrane oxygenation. He received off-label treatment with IV zanamivir [obtained via compassionate-use programme run by GlaxoSmithKline]. Additionally, he was started on an empiric therapy with piperacillin/tazobactam, clarithromycin and linezolid. Eventually, a clinical and radiological improvement was noted. Therefore, extracorporeal membrane oxygenation was discontinued. On day 14, a worsening of his clinical condition along with fever and increased levels of procalcitonin was noted. Therefore, his antimicrobial therapy (piperacillin/tazobactam, clarithromycin and linezolid) was switched to meropenem, vancomycin and anidulafungin. Surveillance swab cultures at this time showed positive results for XDR Acinetobacter baumannii and KPCproducing Klebsiella pneumonia. Therefore, on day 18, he received treatment with colistin [route and dosage not stated], daptomycin and fosfomycin. However, his fever persisted. Therefore, fosfomycin was switched to tigecycline. On day 28, an incomplete response was noted. Additionally, he developed renal failure and liver failure, which was attributed to colistin [outcomes not stated]. Further, the man developed ventilator-associated pneumonia. A chest X-ray showed lung infiltrates. Therefore, he was started on colistin (both IV and aerosolised by a vibrating mesh nebuliser), avibactam/ceftazidime, ampicillin/ sulbactam and rifampicin. On day 35, an off-label cefiderocol (via compassionate-use programme run by the drug manufacturer, Italy) along with linezolid was added to his treatment. Eventually, his conditions rapidly improved. On day 44, he was shifted to the Unit of Infectious and Tropical Diseases with same combination therapy for 14 days. Repeat chest X-rays on day 48 showed complete resolution of lung infiltrates. He was then shifted to the rehabilitation center without antibiotic treatment and with no signs or symptoms of ongoing infections. Author comment: "[O]nset of liver and renal failure was observed, the latter probably due to colistin treatment." Trecarichi EM, et al. Successful treatment with cefiderocol for compassionate use in a critically ill patient with XDR Acinetobacter baumannii and KPC-producing Klebsiella pneumoniae: A case report. Journal of Antimicrobial Chemotherapy 74: 3399-3401, No. 11, Nov 2019. Available from: URL: http://doi.org/10.1093/jac/ 803439947 dkz318 - Italy
0114-9954/19/1783-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 14 Dec 2019 No. 1783
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