Clinical use of intravenous polymyxin B for the treatment of patients with multidrug-resistant Gram-negative bacterial infections: An evaluation of the current evidence

Falagas, Matthew E.; Kyriakidou, Margarita; Voulgaris, Georgios L; Vokos, Filippos; Politi, Sevasti; Kechagias, Konstantinos S.

doi:10.1016/j.jgar.2020.12.026

Cited by 33 publications

(29 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prevalence of AKI in our study was 45.1%, which was similar to the results of a recent meta‐analysis 6 . This prior study showed that among 2994 patients (from 28 studies) who received intravenous polymyxin B, the all‐cause nephrotoxicity was 40.7%.…”

Section: Discussionsupporting

confidence: 90%

“…It is excreted by non‐renal clearance, meaning that dose adjustment in patients with renal dysfunction is not generally needed. Recently, published systematic reviews and meta‐analyses showed that although there is no significant difference in mortality between patients treated with these two polymyxins, polymyxin B appears to have lower nephrotoxicity 5,6 . For these reasons, polymyxin B has become the predominant polymyxin used in many centers.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effectiveness, nephrotoxicity, and therapeutic drug monitoring of polymyxin B in nosocomial pneumonia among critically ill patients

Wang

Chen

et al. 2022

Clinical Respiratory J

View full text Add to dashboard Cite

Objectives We aimed to assess the effectiveness and nephrotoxicity of polymyxin B in critically ill patients with nosocomial pneumonia and to evaluate the utility of its therapeutic drug monitoring (TDM). Methods We retrospectively analyzed patients who received polymyxin B treatment for ≥48 h since the establishment of polymyxin B TDM in a 26‐bed tertiary referral intensive care unit. Univariate and multivariate analyses were conducted to assess the variables associated with polymyxin B effectiveness and nephrotoxicity. Results A total of 62 patients were enrolled. Most (56.5%) of the patients performed TDM, 54.3% of them reached the therapeutic target of area under curve across 24 h at steady state (AUCss,24h) of 50–100 mg h L−1, and 10 patients had an AUCss,24h value of <50 mg h L−1. Thirty‐six (58.1) and 31 (50.0%) patients had favorable clinical and microbiological responses, respectively. Reaching the therapeutic target of AUCss,24h (odds ratio [OR] = 13.15, p = 0.015), a favorable microbiological response (OR = 40.80, p = 0.00), and complicated with septic shock (OR = 0.12, p = 0.021) were independently associated with favorable clinical outcomes of polymyxin B treatment. The incidence of acute kidney injury (AKI) was 45.2%. A lower creatinine clearance (OR = 0.96, p = 0.008) and concomitant treatment with loop diuretics (OR = 5.93, p = 0.046) were predictive of nephrotoxicity. Conclusion Our findings show that TDM of polymyxin B is a valuable intervention, and the achievement of its optimal pharmacodynamic target can improve treatment outcome. Renal insufficiency and concomitant treatment with loop diuretics were found to be associated with the risk of nephrotoxicity.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Effectiveness, nephrotoxicity, and therapeutic drug monitoring of polymyxin B in nosocomial pneumonia among critically ill patients

Wang

Chen

et al. 2022

Clinical Respiratory J

View full text Add to dashboard Cite

show abstract

“…A review and meta-analysis conducted by Falagas and his coworkers showed that the all-cause nephrotoxicity of 2994 adult patients (from 28 studies) treated with intravenous polymyxin B was 40.7% ( Falagas et al, 2021 ), and our study showed a lower incidence of AKI in children with polymyxin B than in adult patients at 27.3%, closer to the data reported by Siddiqui et al on children (21.4% incidence of nephrotoxicity) ( Siddiqui et al, 2014 ). However, a meta-analysis of the clinical data of 405 children treated with colistin showed that the incidence of nephrotoxicity in children treated with colistin was 6.1% ( Karageorgos et al, 2019 ), much lower than that in our study.…”

Section: Discussionsupporting

confidence: 86%

Effectiveness and Nephrotoxicity of Intravenous Polymyxin B in Carbapenem-Resistant Gram-Negative Bacterial Infections Among Chinese Children

et al. 2022

View full text Add to dashboard Cite

Background: No clinical study on the use of polymyxin B in Chinese children has been reported, thus making it difficult for pediatric clinicians to rationally select these drugs.Methods: A retrospective analysis of children treated with polymyxin B during hospitalization in a hospital from June 2019 to June 2021 was conducted to analyze its effectiveness and the incidence of acute kidney injury (AKI) during treatment with polymyxin B.Results: A total of 55 children were included in this study, and the results showed that the intravenous polymyxin B-based regimen had an effective rate of 52.7% in the treatment of Carbapenem-resistant Gram-negative bacterial (CR-GNB) infection in children. The results of the subgroup analysis showed that the course of treatment was longer in the favorable clinical response group than in the unfavorable outcome group (p = 0.027) and that electrolyte disturbances in children during the course of treatment could lead to unfavorable clinical outcomes (p = 0.042). The risk of incidence of AKI during treatment was 27.3%, and the all-cause mortality rate in the children on their discharge from the hospital was 7.3%.Conclusion: Polymyxin B can be used as a salvage therapy for CR-GNB infection in children when no other susceptible antibiotics are available, and the monitoring of kidney function should be strengthened.

show abstract

“…Polymyxin B was introduced in the 1950s and has been gradually replaced by safer clinical antibiotics due to its high incidence of adverse effects, especially acute kidney injury (AKI, 10–50%), 1 , 2 and the detection of carbapenem-resistant organisms (CROs) has posed great challenges for clinical treatment in recent years. 3–5 In 2017, the World Health Organization (WHO) published a catalog of 12 families of bacteria for which new antibiotics are urgently needed, and the first three of them turn out to be CROs, 6 making the clinical options extremely limited.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Acute Kidney Injury Induced by Intravenous Polymyxin B in Chinese Patients with Severe Infection

Jia¹,

Guo²,

Zhao³

et al. 2022

IDR

View full text Add to dashboard Cite

Purpose To analyze the risk factors for acute kidney injury (AKI) induced by intravenous polymyxin B in Chinese patients with severe infection and to provide a reference for clinicians and pharmacists. Methods We retrospectively analyzed patients treated with intravenous polymyxin B from August 2018 to August 2020 in a Chinese teaching hospital. Renal function was evaluated during therapy with polymyxin B and at the end of the treatment. Univariate and multivariate analyses were conducted to determine risk factors for the nephrotoxicity of polymyxin B. Results A total of 321 patients were included, and the incidence of AKI was 26.2% and 25.1% during polymyxin B therapy and at the end of treatment, respectively. Independent risk factors for AKI during therapy with polymyxin B were septic shock, coadministration of vancomycin or loop diuretics, and advanced age (≥60 years), while the incidence of AKI during treatment with polymyxin B was considered to be an independent risk factor for AKI at the end of the treatment. Conclusion Septic shock, coadministration of vancomycin or loop diuretics, and advanced age (age ≥60 years) were found to be risk factors for AKI induced by intravenous polymyxin B. Clinicians and pharmacists should consider these factors when designing and recommending treatment with polymyxin B.

show abstract

Clinical use of intravenous polymyxin B for the treatment of patients with multidrug-resistant Gram-negative bacterial infections: An evaluation of the current evidence

Cited by 33 publications

References 65 publications

Effectiveness, nephrotoxicity, and therapeutic drug monitoring of polymyxin B in nosocomial pneumonia among critically ill patients

Effectiveness, nephrotoxicity, and therapeutic drug monitoring of polymyxin B in nosocomial pneumonia among critically ill patients

Effectiveness and Nephrotoxicity of Intravenous Polymyxin B in Carbapenem-Resistant Gram-Negative Bacterial Infections Among Chinese Children

Risk Factors for Acute Kidney Injury Induced by Intravenous Polymyxin B in Chinese Patients with Severe Infection

Contact Info

Product

Resources

About