Efficacy and safety of polymyxin B in carbapenem-resistant gram-negative organisms infections

Xia, Guolian; Jiang, Ronglin

doi:10.1186/s12879-021-06719-y

Cited by 7 publications

(7 citation statements)

References 27 publications

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“…The duration of treatment for PES was strongly associated with effectiveness. Similar to the study of Xia et al on PBS ( 42 ) and consistent with the consensus recommended duration, the treatment groups with durations of 8–14 days and more than 14 days exhibited significantly greater efficacy than those with durations of 7 days or less. Longer treatment duration and greater cumulative doses of medication, while boosting efficacy, can increase the risk of adverse effects in patients, whereas in this trial there was no differences in the prevalence of AKI between efficacy groups.…”

Section: Discussionsupporting

confidence: 81%

Efficacy and safety of polymyxin E sulfate in the treatment of critically ill patients with carbapenem-resistant organism infections

et al. 2022

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ObjectivePolymyxins are currently the last line of defense in the treatment of carbapenem-resistant organisms (CRO). As a kind of polymyxin available for clinical use in China, we aim to explore the efficacy and safety of colistin sulfate (Polymyxin E sulfate, PES) in this study.MethodsThis real-world retrospective study included 119 patients diagnosed with CRO infection and treated with PES for more than 72 h, from May 2020 to July 2022 at West China Hospital. The primary outcome was clinical efficacy at the end of treatment, and secondary outcomes included microbial response, in-hospital mortality and incidence of nephrotoxicity.ResultsThe effective clinical and microbiological responses were 53.8% and 49.1%, respectively. And the in-hospital mortality was 27.7%. Only 9.2% of patients occurred with PES-related nephrotoxicity. Multivariate analysis revealed that duration of PES was an independent predictor of effective therapy, while age-adjusted Charlson comorbidity index (aCCI) and post-treatment PCT(p-PCT) were independent risk factors for poor outcome.ConclusionsPES can be a salvage treatment for CRO-induced infections with favorable efficacy and low nephrotoxicity. The treatment duration of PES, aCCI and p-PCT were factors related to the clinical effectiveness of PES.

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Section: Discussionsupporting

confidence: 81%

Efficacy and safety of polymyxin E sulfate in the treatment of critically ill patients with carbapenem-resistant organism infections

et al. 2022

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“…It is also possible that the renal impairment of patients in our study may have been complicated by other factors, such as other nephrotoxic drug use, multiple organ dysfunction syndrome, and septic shock. Multiple studies have shown that polymyxin B has dosedependent nephrotoxicity (27,35,36). Nelson et al found a dose of ≥250 mg per day was associated with a higher incidence of AKI (37).…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have shown that polymyxin B has dose-dependent nephrotoxicity ( 27 , 35 , 36 ). Nelson et al found a dose of ≥250 mg per day was associated with a higher incidence of AKI ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy and nephrotoxicity of intravenous colistin sulfate in the treatment of carbapenem-resistant gram-negative bacterial infections: a retrospective cohort study

Jin¹,

Zhu²,

Zhu³

et al. 2022

Ann Transl Med

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Background: Carbapenem-resistant gram-negative bacteria (CR-GNB) are becoming increasingly important bacterial pathogens in critically ill patients. Several clinicians use Intravenous colistin sulfate to treat infections due to CR-GNB, although the clinical data is limited. The aim of our retrospective observational study was to evaluate the effectiveness and nephrotoxicity of intravenous colistin sulfate in the treatment of CR-GNB infections.Methods: Fifty critically ill intensive care patients with infections due to CR-GNB were retrospectively enrolled between January 2020 and December 2021 in the Zhejiang Provincial People's Hospital. Favorable clinical response rate, bacterial clearance rate, nephrotoxicity, and 28-day mortality were evaluated. Results:The overall favorable clinical response rate was 58%, the bacterial clearance rate was 40%, and the 28-day all-cause mortality was 44%. Temperature, neutrophil count, C-reaction protein (CRP), procalcitonin (PCT), creatinine (Cr), and lactate levels were also significantly decreased (P<0.05). The major adverse reaction is nephrotoxicity, and renal function was evaluated on the day before and after treatment with colistin sulfate. Possible nephrotoxicity was observed in three patients (6%). Backward logistic regression was conducted to determine risk factors for the nephrotoxicity of colistin sulfate, the result showed there were no significant differences in the duration and dose of colistin sulfate.Conclusions: Our results provide evidence for the positive clinical efficacy and safety of colistin sulfate.Appropriate use of colistin sulfate may be viable and safe in the treatment of severe infections caused by CR-GNB.

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“…No serious toxicity was observed in the group of patients who received a long-term intravenous colistin sulfate treatment (24). Xia et al found that approximately 10% of patients treated with polymyxin B for CRO infections developed acute kidney injury, but 23.5% recovered after discontinuation colistin sulfate treatment (14). However, a safety study of PMB in Chinese patients, excluding those receiving renal replacement therapy, found that 38.7% developed nephrotoxicity, and the daily dose of PMB was a risk factor for nephrotoxicity (P=0.026) (25).…”

Section: Independent Factors Associated With Mortalitymentioning

confidence: 99%

“…Polymyxins are polypeptide antibiotics, and mainly include polymyxin B (PMB), colistin sulfate, and colistimethate sodium (CMS). Currently, several studies have investigated the clinical efficacy and safety of polymyxin B and CMS in the treatment of CRO infections, including CRPA, CRAB, and CRKP infections (12)(13)(14)(15). The colistin sulfate is available late.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of colistin sulfate in the treatment of infections caused by carbapenem-resistant organisms: a multicenter retrospective cohort study

Peng¹,

Zhang²,

Chen³

et al. 2023

J Thorac Dis

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Background: Polymyxins have become an important treatment option for carbapenem-resistant organisms (CRO) infections. However, there is a rare of clinical studies on colistin sulfate. This study sought to investigate the rate of clinical improvement and adverse reactions of colistin sulfate in the treatment of severe infections caused by CRO in critically ill patients and assess the factors associated with 28-day all-cause mortality.Methods: This multicenter retrospective cohort study included intensive care unit (ICU) patients who received colistin sulfate due to CRO infections during July 2021 and May 2022. The primary endpoint was clinical improvement at end of therapy. Secondary endpoints included adverse reactions bacterial clearance rate and 28-day all-cause mortality.Results: A total of 122 patients, who were included between July 2021 and May 2022, were included in this study, of whom 86 (70.5%) showed clinical improvement and 36 (29.5%) showed clinical failure. The comparison of the clinical data of the patients showed that the median sequential organ failure assessment (SOFA) score was higher in the failure group than the improvement group {9.5 [7,11] vs. 7 [4, 9], P=0.002}, the proportion of patients receiving extracorporeal membrane oxygenation (ECMO) was higher in the failure group than the improvement group (27.8% vs. 12.8%, P=0.046), and the median duration of treatment was longer in the improvement group than the failure group {12 [8, 15] vs. 5.5 [4, 9.75], P<0.001}. A total of 5 (4.1%) patients suffered from acute kidney injury due to increases in creatinine during colistin sulfate treatment. The Cox regression survival analysis showed that the SOFA score [hazards ratio (HR) =1.198, P=0.001], ECMO treatment (HR =2.373, P=0.029), and duration of treatment (HR =0.736, P<0.001) were independently associated with 28-day all-cause mortality.Conclusions: Colistin sulfate is a reasonable choice for the treatment of CRO infections in the current treatment options are limited. The possible kidney injury caused by the colistin sulfate requires intensive monitoring.

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Efficacy and safety of polymyxin B in carbapenem-resistant gram-negative organisms infections

Cited by 7 publications

References 27 publications

Efficacy and safety of polymyxin E sulfate in the treatment of critically ill patients with carbapenem-resistant organism infections

Efficacy and safety of polymyxin E sulfate in the treatment of critically ill patients with carbapenem-resistant organism infections

Clinical efficacy and nephrotoxicity of intravenous colistin sulfate in the treatment of carbapenem-resistant gram-negative bacterial infections: a retrospective cohort study

Efficacy and safety of colistin sulfate in the treatment of infections caused by carbapenem-resistant organisms: a multicenter retrospective cohort study

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