İlk doz kolistin kullanımı sonrasında kolistine bağlı olarak nöropati gelişen bir olgu

Kateter enfeksiyonlarının en sık etkeni cilt florasında yer alan stafilokoklar ve diğer Gram-pozitif bakterilerdir. Citrobacter freundii çoğunlukla nozokomiyal enfeksiyon etkeni olup, nadiren kateterle ilişkili kan dolaşımı enfeksiyonuna neden olur. Bu yazıda, hemodiyalize giren 39 yaşında bir erkek hastada Citrobacter freundii’ye bağlı olarak gelişen kateterle kan dolaşımı enfeksiyonu gelişen bir olgu sunuldu. Hastanın periferik kan ve kateter içinden alınan kan örneklerinde Citrobacter freundii üredi. Hastaya 10 gün süreyle seftriakson tedavisi uygulandı, tedavi sonrası klinik ve laboratuvar bulguları düzeldi. Sonuç olarak, özellikle hemodiyalize giren hastalarda nadirde olsa Gram-negatif bakterilerden Citrobacter freundii’nin de kateterle ilişkili kan dolaşımı enfeksiyonu etkeni olabileceği akılda tutulmalıdır.

Anahtar Kelimeler:

Çoğul ilaca dirençli, K.pneumoniae, , kolistin, yan etki, nörotoksisite

A case with neuropathy due to colistin after using first dose of colistin

Colistin is an antibiotic commonly used in the treatment of infection due to multiple drug resistant Gram negative bacilli. Colistin side effects include of nephropathy and neuropathy. Neurotoxicity due to colistin can be occur as paresthesia, dizziness, visual changes, and neuromuscular blockade with ataxia. In this article, a case of 68-year-old female patient with a diagnosis of urinary tract infection due to resistant Klebsiella pneumoniae and treatment of imipenem and colistin after the first dose of colistin and her treatment colistin was stoped upon the development of paresthesia in the lips and fingers. After discontinuation of the drug, the patient's paresthesia improved, and the treatment was continued with a combination of imipenem and trimethoprim-sulfomethoxazole. As a result, patients receiving colistin therapy should be closely monitored for symptoms of neuropathy and drug therapy should be discontinued if neurotoxicity develops.

Keywords:

Multidrug resistance, Klebsiella.pneumoniae, colistin, side effect, neurotoxicity,

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1. Nørgaard SM, Jensen CS, Aalestrup J, Vandenbroucke-Grauls CMJE, de Boer MGJ, Pedersen AB. Choice of therapeutic interventions and outcomes for the treatment of infections caused by multidrug-resistant gram-negative pathogens: a systematic review. Antimicrobial Resistance and Infection Control (2019) 8:170.
2. Karaiskos İ and Giamarellou H. Multidrug-resistant and extensively drug-resistant Gram-negative pathogens: current and emerging therapeutic approaches. Expert Opin Pharmacother. 2014; 15(10) : 1351–1370.
3. Tonny Loho , Anti Dharmayanti . Colistin: an antibiotic and its role in multiresistant Gram-negative infections. Acta med Indones 2015; 47(2): 157-68.
4 Falagas EM, Kasiakou SK. Colistin: the revival of polymyxins for the management of multidrug resistant Gram-negative bacterial infections. Clin Infect Dis. 2005;40(5):1333-41.
5. Tamma.PD, Newland JG, Pannaraj MD, et al. The use of intravenous colistin among children in the United States: Results from a multicenter, case series. Pediatr Infect Dis J. 2012;32:17-22.
6 .Ecemiş S. Yoğun bakım ünitelerinde kolistin kan düzeyi izlemi ve değerlendirilmesi. Yüksek Lisans Tezi. Ankara, 2019 7. Kelesidis T, Falagas ME. The safety of polymyxin antibiotics. Expert Opin Drug Saf. 2015;14(11):1687-701.
8. Pogue JM, Lee J, Marchaim D, Yee V, Zhao JJ, Chopra T, ve ark. Incidence of and risk factors for colistin associated nephrotoxicity in a large academic health system. Clin Infect Dis. 2011;53(9):879-84.
9. DeRyke CA, Crawford AJ, Uddin N, Wallace MR. Colistin dosing and nephrotoxicity in a large community teaching hospital. Antimicrob Agents Chemother 2010;54(10):4503-5.
10. Falagas ME, Kasiakou SK. Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Crit Care. 2006;10(1):R27.
11. Bulut C, Yamazhan T, Işıkgöz M, Pullukçu H, Ulusoy S.İlk Doz kolistin tedavisini takiben gelişen toksisite: Kolistin ne kadar güvenli? ANKEM Derg 2016;30(2):57-61.
12. Duncan DA. Colistin toxicity. Neuromuscular and renal manifestations. Two cases treated by hemodialysis. Minn Med. 1973;56(1):31-5.
13. John Ng , Gosbell IB, Kelly JA , Boyle MJ and Ferguson JK. Cure of multiresistant Acinetobacter baumannii central nervous system infections with intraventricular or intrathecal colistin: case series and literature review. Journal of Antimicrobial Chemotherapy 2006; 58; 1078–1081.
14. Velkova T, Daib C, Ciccotostoc GD , Cappaic R , Hoyerd D, Li J. Polymyxins for CNS infections: Pharmacology and neurotoxicity. Pharmacology and Therapeutics (2017), http://dx.doi.org/10.1016/j.pharmthera.2017.07.012.
15. Koch-Weser J, Sidel VW, Federman EB, Kanarek P, Finer DC, Eaton AE. Adverse effects of sodium colistimethate: manifestations and specific reaction rates during 317 courses of therapy. Ann Intern Med. 1970;72(6):857-868.
16. Reed MD, Stern RC, O’Riordan MA, Blumer JL The pharmacokinetics of colistin in patients with cystic fibrosis, J Clin Pharmacol 2001;41(6):645-54.

Journal of Medicine and Palliative Care-Cover

Başlangıç: 2020
Yayıncı: MediHealth Academy Yayıncılık

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