Factores asociados a nefrotoxicidad por polimixina B en un hospital universitario de Neiva, Colombia. 2011-2015

Osorio, Johanna; Barreto, Jackeline; Samboni, Claudia F; Candelo, Lina; Alvarez, Luis Carlos Fernandez; Benavidez, Susana; Téllez, Roso P; Santofimio, Dagoberto; Ramos, Jorge Andrés; Gómez, Carlos A.

doi:10.4067/s0716-10182017000100001

Cited by 14 publications

(11 citation statements)

References 16 publications

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“…In fact, overall AKI rates were similar to the average rate of 40% found in previous studies of PMB (range, 20% to 60%) (27)(28)(29)(30)(31)(32)(33)(34). The proportion of patients with renal failure in our study might be considered higher (46.3% of patients with AKI) than that described in reports of previous studies, which presented an average proportion of patients with renal failure of approximately 22% (but the average proportion ranged widely from 4% to 50%) (27)(28)(29)(30)(31)(32)(33)(34), and the onset of failure may have occurred earlier in our sample than patients in previous studies. The number of patients requiring renal replacement therapy in our cohort may also be considered high, potentially indicating a higher risk for more severe kidney damage in patients receiving these high doses, although a definitive conclusion requires a proper control group exposed to lower doses.…”

Section: Discussionsupporting

confidence: 87%

Severe Infusion-Related Adverse Events and Renal Failure in Patients Receiving High-Dose Intravenous Polymyxin B

John

Falci

Rigatto

et al. 2018

Antimicrob Agents Chemother

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The use of very high doses of polymyxin B (PMB) against carbapenem-resistant Gram-negative bacilli has been addressed in experiments as a strategy to improve bacterial killing and suppress resistance emergence. However, the toxicities of very high doses in patients are unknown. We conducted a retrospective cohort study assessing patients receiving PMB at>3 mg/kg of body weight/day or a total dose of ≥250 mg/day. The main outcomes were severe infusion-related adverse events according to the Common Terminology Criteria for Adverse Events and the renal failure category of RIFLE criteria for acute kidney injury (AKI) during treatment. A total of 222 patients were included for analysis of infusion-related events. The mean PMB dose was 3.61 ± 0.97 mg/kg/day (median total dose/day = 268 mg). Severe infusion-related adverse events occurred in two patients, resulting in an incidence of 0.9% (95% confidence interval, 0.2 to 3.2%); one was classified as a life-threatening adverse event, and one was classified as a severe adverse event. Renal failure was analyzed in 115 patients, and 25 (21.7%) patients presented renal failure (54 [47.0%] developed any degree of AKI, categorized as risk [27.8%], injury [25.9%], and failure [46.3%]). Treatment with a vasoactive drug, concomitant treatment with nephrotoxic drugs, and baseline creatinine clearance were independent risk factors for renal failure. Neither the PMB daily dose scaled by body weight nor the total daily dose was associated with renal failure. The in-hospital mortality rate was 60% (134 patients): 26% of deaths (57 patients) occurred during treatment, and none occurred during infusion. Our data suggest that high-dose schemes have an acceptable safety profile and could be further tested in clinical trials assessing strategies to improve patient outcomes and minimize the emergence of PMB resistance.

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Section: Discussionsupporting

confidence: 87%

Severe Infusion-Related Adverse Events and Renal Failure in Patients Receiving High-Dose Intravenous Polymyxin B

John

Falci

Rigatto

et al. 2018

Antimicrob Agents Chemother

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“…Asimismo, se determinó que la IHQ de tipo órgano espacio es un factor asociado a la letalidad, similar a lo encontrado por Horasan et al 18 . La letalidad en este tipo de infecciones sobreviene por la ubicación en sitios anatómicos complejos y con irrigación comprometida, que hacen dispendiosa la penetración del antibiótico, máxime cuando un gran número de estas infecciones son producidas por gérmenes multirresistentes que presentan una elevada letalidad 37,38 , principalmente debido a la utilización de medicamentos que producen efectos adversos serios 39 .…”

Section: Discussionunclassified

Factores asociados a letalidad en pacientes con infección de herida quirúrgica. Estudio de casos y controles

Andrade-Mendez¹,

Ramos-Castañeda²,

M³

et al. 2020

Duazary

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Existe evidencia sobre los factores de riesgos asociados a la infección de la herida quirúrgica (IHQ), pero se desconocen estudios que hayan evaluado los factores asociados a la letalidad por la IHQ. Se propone un estudio para determinar los factores asociados a la letalidad en pacientes que desarrollaron una IHQ. Se realizó un estudio de casos y controles anidado a una cohorte de pacientes adultos diagnosticados con IHQ durante el periodo 2015 – 2016, en un hospital universitario de la región sur de Colombia. Los casos fueron pacientes con IHQ que presentaron letalidad dentro de los 30 días posteriores al inicio de la infección y los controles aquellos con IHQ que no fallecieron durante los 30 días. 150 pacientes cumplieron los criterios de selección. Los casos (fallecidos) correspondieron al 19,3%, quedando el grupo de los controles (vivos) con un 80,7%. Se encontró que controlando la edad y los días de hospitalización previos al procedimiento quirúrgico, la IHQ tipo órgano espacio es un factor asociado con letalidad en pacientes infectados (OR=2,5 IC95% 1,1 – 6,1). La letalidad en pacientes con IHQ fue elevada y representa un problema de salud pública por las consecuencias que ocasiona al paciente.

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“…Due to the difficult to treat nature of infections caused by carbapenem-producing K. pneumoniae (CpKP), there are limited treatment options that are currently available. Studies have reported that antibiotics such as colistin, gentamicin, tigecycline, and fosfomycin that are used for the treatment of infections caused by CpKP can lead to severe adverse effects such as nephrotoxicity ( Akajagbor et al, 2013 ; Osorio et al, 2017 ) and hepatotoxicity ( Lim et al, 2010 ; Florescu et al, 2012 ). According to ( Tumbarello et al, 2012a ; Daikos et al, 2014 ), it has been reported that during bacteremic infections, combination treatment regimens are recommended; however, it has been reported by Gutiérrez-Gutiérrez et al (2017) that, combination therapies should be used when patients are in critical conditions.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Therapeutic Outcomes of Antibiotic Regimen Against Carbapenemase-Producing Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Carbapenemase-producing Klebsiella pneumoniae (CpKP) has been implicated as an increasing threat to public health. CpKP is a ubiquitous, opportunistic pathogen that causes both hospital and community acquired infections. This organism hydrolyzes carbapenems and other β-lactams and thus, leading to multiple resistance to these antibiotics. Despite the difficult to treat nature of infections caused by CpKP, little has been discussed on the mortality, clinical response and microbiological success rates associated with various antibiotic regimen against CpKP. This meta-analysis was designed to fill the paucity of information on the clinical impact of various antibiotic therapeutic regimens among patients infected with CpKP.Materials and Methods: Literature in most English databases such as Medline through PubMed, Google Scholar, Web of Science, Cochrane Library and EMBASE, were searched for most studies published between the years 2015–2020. Data were analyzed using the R studio 2.15.2 statistical software program (metaphor and meta Package, Version 2) by random-effects (DerSimonian and Laird) model.Results: Twenty-one (21) studies including 2841 patients who had been infected with CpKP were analysed. The overall mortality rate was 32.2% (95%CI = 26.23–38.87; I2 = 89%; p-value ≤ 0.01, Number of patients = 2716). Pooled clinical and microbiological success rates were 67.6% (95%CI = 58.35–75.64, I2 = 22%, p-value = 0.25, Number of patients = 171) and 74.9% (95%CI = 59.02–86.09, I2 = 53%, p-value = 0.05, Number of patients = 121), respectively. CpKP infected patients treated with combination therapy are less likely to die as compared to those treated with monotherapy (OR = 0.55, 95%CI = 0.35–0.87, p-value = 0.01, Number of patients = 1,475). No significant difference existed between the mortality rate among 60years and above patients vs below 60years (OR = 0.84, 95%CI = 0.28–2.57, p-value = 0.76, 6 studies, Number of patients = 1,688), and among patients treated with triple therapy vs. double therapy (OR = 0.50, 95%CI = 0.21–1.22, p-value = 0.13, 2 studies, Number of patients = 102). When compared with aminoglycoside-sparing therapies, aminoglycoside-containing therapies had positive significant outcomes on both mortality and microbiological success rates.Conclusion: New effective therapies are urgently needed to help fight infections caused by this organism. The effective use of various therapeutic options and the strict implementation of infection control measures are of utmost importance in order to prevent infections caused by CpKP. Strict national or international implementation of infection control measures and treatment guidelines will help improve healthcare, and equip governments and communities to respond to and prevent the spread of infectious diseases caused by CpKP.

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Factores asociados a nefrotoxicidad por polimixina B en un hospital universitario de Neiva, Colombia. 2011-2015

Cited by 14 publications

References 16 publications

Severe Infusion-Related Adverse Events and Renal Failure in Patients Receiving High-Dose Intravenous Polymyxin B

Severe Infusion-Related Adverse Events and Renal Failure in Patients Receiving High-Dose Intravenous Polymyxin B

Factores asociados a letalidad en pacientes con infección de herida quirúrgica. Estudio de casos y controles

Evaluation of the Therapeutic Outcomes of Antibiotic Regimen Against Carbapenemase-Producing Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

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