Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection

Liang, Qiqiang; Huang, Man; Xu, Zhijiang

doi:10.1016/j.bjid.2018.12.004

Cited by 37 publications

(30 citation statements)

References 13 publications

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“…In a study on the timing of PMB administration in CRKP-infected patients, early administration of PMB was found to be bene cial for improving bacterial clearance and patient survival. [8] In our study, there was no statistical difference in the timing of PMB medication between different clinical effects. This may indicate that after the con rmation of CROs infection, the timing of PMB medication may not affect the clinical e cacy of PMB in the short term.…”

Section: Discussioncontrasting

confidence: 49%

“…[7] Related studies have demonstrated the e cacy, toxicity, and e cacy prediction of PMB in the treatment of CRO infections. Early treatment with PMB [8] and sound renal function [9] usually lead to better outcomes. However, PMB may have an inferior microbiologic clearance rate of carbapenemresistant Klebsiella pneumoniae (CRKP) compared with aminoglycoside.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Effects of Polymyxin B in Patients infected with Carbapenem-resistant organisms

et al. 2020

Preprint

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Purpose: Carbapenem-resistant organisms (CROs) pose great challenges for clinical treatment. Polymyxin B (PMB) is one of the “last resort” choices of CRO infections. We explored the possible factors affecting PMB efficacy. Methods: This retrospective study involved CRO infected patients treated with PMB for ≥72 h. The endpoint indicator was clinical efficacy. We compared the characteristics (demographics, pathogenic bacteria, PMB treatment) between patients who had “clinical success” (CS) and “clinical failure” (CF).Results: A total of 192 patients were enrolled: 110 in the CS group and 82 in the CF group. The total cumulative dose for the CS group was higher than the CF group [1100 (700–1443.75) vs. 800 (500–1112.5) mg; P = 0.001]. Treatment duration in the CS group was longer than the CF group [11 (8–14) vs. 8 (6–11) days; P < 0.000]. Multivariate logistic regression analysis showed mechanical ventilation, vasoactive agents, multiple-site infection, and total cumulative dose to be independently associated with clinical efficacy. Cox survival analysis for 30-day mortality also showed that the use of vasoactive agents and the total cumulative dose of PMB could influence survival time and mortality rate independently.Conclusion: PMB had good efficacy and a low prevalence of adverse reactions. The total cumulative dose，duration of PMB treatment, mechanical ventilation, vasoactive agents, and multiple-site infection were factors associated with the clinical efficacy of PMB.

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Section: Discussioncontrasting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Clinical Effects of Polymyxin B in Patients infected with Carbapenem-resistant organisms

et al. 2020

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“…This may be related to the regulation of antibiotics use in carbapenems and tigecycline recently, and to the approves of polymyxin B and ceftazidime-avibactam in the domestic market. More clinical experience of clinicians in CRKP bloodstream infection and earlier use of appropriate antibiotics may be associated with lower mortality 23 . The multiple logistic regression model included five major risk factors including age, septic shock, acute kidney injury, severe thrombocytopenia, and immunodeficiency.…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Algorithms to Predict the Mortality of Carbapenem Resistant Klebsiella Pneumoniae bacteremia

Liang

Qian

Chen

et al. 2019

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Purpose To establish mortality prediction models in 14 days of Carbapenem-Resistant Klebsiella Pneumoniae bacteremia using Machine learning.Materials and Methods It is a single-center retrospective study. We collect the relevant clinical information of all patients with Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) bacteremia in the past 5 years using the local database. Data analysis and verification are carried out by multiple logical regression, decision tree, random forest, support vector machine (SVM), and XGBoost.Result This study includes 187 patients with 40 related variables. In multiple logical regression, acute renal injury (P=0.003), Apache II score (P=0.036), immunodeficiency (P=0.025), severe thrombocytopenia (P=0.025) and septic shock (P=0.044) are the high-risk factors for 14 days mortality of CRKP bloodstream infections. According to the importance of those parameters, risk scoring is established to predict the survival rate of CRKP bacteremia. The analysis of the five models, with 70% training set and 30% test set, show the comprehensive performance of random forest (AUROC=0.953, precision=91.85%) is slightly better than that of XGBoost (AUROC=0.912, precision=86.41%) and SVM (AUROC=0.936, precision=79.89%) in predicting 14-day mortality of CRKP bacteremia. The multiple logical regression model (AUROC=0.825, precision=81.52%) is the second, and the decision tree model (AUROC=0.712, precision=79.89%) is not very ideal.Conclusion Machine learning has good performances in predicting 14-day mortality of CRKP bacteremia than multiple logical regression. Acute renal injury, severe thrombocytopenia, and septic shock are the high-risk factors of CRKP bacteremia mortality.

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“…The mortality rates more than 47% have been reported for CRGNB infections [5,[9][10][11][12][13]. At the same time the marked decline in the development of newer antibiotics creates a real daunting challenge for the clinicians to against CRGNB [2,14].…”

Section: Introductionmentioning

confidence: 99%

A Real-World Study for Polymyxin B in the Treatment of Carbapenems Resistant Gram-Negative Bacilli

Zhang

Duan

et al. 2020

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Background: High morbidity and mortality due to carbapenem-resistant Gram-negative bacilli (CRGNB) was a challenge for clinicians has led to the resurgence of polymyxin B (PMB) use in the last decade. The goal of our multicenter, real-world study was to evaluate the efficacy and safety of PMB in the treatment of CRGNB.Methods: The real-world study included the patients with intravenous PMB at least 7 days during the period of October 2018 to June 2019. Data was collected from electronic patients register and follow-up. The primary outcome was 28-day mortality, the secondary outcomes included hospital mortality, occurrence of adverse events during PMB therapy. Associations between these variables and 28-day mortality or all-cause hospital mortality were explored through univariate analyses and multivariable logistic regression. At the same time, therapeutic effects were observed. Results: The study included 100 patients. There were 39% presence of septic shock, 49% need mechanical ventilation at the beginning of therapy. The infection and condition improved after 7 days of PMB treatment. The major adverse reactions occurred in 16 cases (16%). The overall 28-day mortality was 40%. In terms of clinical characteristics, mean Sequential Organ Failure Assessment (6.77 versus 9.25，P = 0.004)，mean Acute Physiology and Chronic Health Evaluation II (APACHEII) scores (16.17 versus 19.78, P = 0.016) and the number of patient with mechanical ventilation (21 versus 30, P = 0.000) or septic shock (17 versus 32, P = 0.000) were lower in survivors group than nonsurvivors group. The mortality of 85 patients with identify pathogens was 38.82%, while the mortality of patients with negative pathogen culture results was 46.67% (P = 0.580). Multivariate analysis showed that mechanical ventilation (P = 0.023, OR = 3.5; CI: 1.194–10.739), septic shock (P = 0.002, OR = 5.960; CI: 1.923–18.473) were associated with 28-day mortality.Conclusion: Our research found that PMB may be as effective and safe as standard antibiotics for the treatment of CRGNB. Timely and appropriate use of PMB will have a positive impact on the clinical outcomes of patients with sepsis in CRGNB.

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Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection

Cited by 37 publications

References 13 publications

Clinical Effects of Polymyxin B in Patients infected with Carbapenem-resistant organisms

Clinical Effects of Polymyxin B in Patients infected with Carbapenem-resistant organisms

Machine Learning Algorithms to Predict the Mortality of Carbapenem Resistant Klebsiella Pneumoniae bacteremia

A Real-World Study for Polymyxin B in the Treatment of Carbapenems Resistant Gram-Negative Bacilli

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