Amikacin monotherapy for sepsis caused by panresistant Pseudomonas aeruginosa

Abstract

Two patients with severe sepsis due to panresistant Pseudomonas aeruginosa, deteriorating despite therapy with colistin and β-lactams, were cured with a high daily dose (25 to 50 mg/kg) of amikacin to obtain a peak/MIC ratio of at least 8 to 10 (MIC = 16 μg/ml). Concomitant use of continuous venovenous hemodiafiltration (CVVHDF) provided no deterioration in renal function after treatment. High dosage of aminoglycosides combined with CVVHDF may represent a valuable therapeutic option for infection due to multiresistant pathogens.

FIG. 1.

Peak concentrations of amikacin in patient 1 (daily dose of amikacin, 2,500 mg [black circles]) and patient 2 (daily dose of amikacin, 3,000 mg [white circles], and then 6,000 mg following day 4 [white triangles]). Dotted lines indicate amikacin levels between 108 and 160 μg/ml, corresponding to 8 to 10 times the MIC (MIC = 16 μg/ml) for the isolated Pseudomonas strains.

FIG. 2.

Evolution of C-reactive protein (CRP) and creatinine levels in patient 1 (A) and patient 2 (B) during the ICU stay. CVVHDF, continuous venovenous hemodiafiltration.