Efficacy of intravenous plus intrathecal/intracerebral ventricle injection of polymyxin B for post-neurosurgical intracranial infections due to MDR/XDR Acinectobacter baumannii: a retrospective cohort study

Pan, Sijun; Huang, Xiaofang; Wang, Yesong; Li, Li; Zhao, Changyun; Yao, Zhong-Xiang; Cui, Wei; Zhang, Gensheng

doi:10.1186/s13756-018-0305-5

Cited by 47 publications

(46 citation statements)

References 36 publications

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“…The meta-analysis was performed with 11 studies [13,14,[19][20][21][22][23][24][25][26][27], including a total of 1052 patients (496 patients in polymyxins group and 556 patients in control group). The characteristics of the included studies are listed in Table 1.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The characteristics of the included studies are listed in Table 1. These 11 studies consisted of 8 retrospective studies [13,14,19,22,[24][25][26][27], 2 RCTs [20,21] and 1 prospective study [23]. The research hospitals are in North America and Europe (USA, Greece, Spain, Turkey, and France), Middle East (Iran, and Israel) and Asia (Taiwan, China, and Thailand).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…The research hospitals are in North America and Europe (USA, Greece, Spain, Turkey, and France), Middle East (Iran, and Israel) and Asia (Taiwan, China, and Thailand). Two studies [25,26] assessed patients with intracranial infections (such as meningitis). One study [13] reported on patients with intra-abdominal infection.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies [19,23,27] included more than one site of infection. In polymyxins group, colistin was administered in 10 studies [13, 14, 19-24, 26, 27] and polymyxin B [25] was used in only one study. In the control group, carbapenems, tetracyclines, cephalosporins, β-lactam/β-lactamase inhibitors, quinolones, aminoglycosides and glycylcycline (tigecycline) were the most commonly used alternative antibiotics.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In 7 studies [13, 14, 19-21, 23, 24], the intravenous (IV) route of administration was used in both polymyxins and control groups. But in the other 4 studies [22,[25][26][27], patients in polymyxins group received IV and intrathecal/intracerebral (IT) polymyxins or IV and inhaled (IH) polymyxins, while patients in control group were given IV antibiotics only. One-month mortality was reported in all studies, clinical and microbiological response was reported in 5 studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis

et al. 2020

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Background: The prevalence of infections due to carbapenem-resistant Acinetobacter baumannii (CRAB) is on the rise worldwide. Polymyxins are considered as last-resort drugs for CRAB infections, but there is still controversy regarding the efficacy and safety of polymyxins based therapies in CRAB infections. The present systematic review was designed to compare the efficacy and safety of polymyxins based therapies versus non-polymyxins based therapies in CRAB infections. Methods:We performed a systematic literature search in PubMed, Embase, CINAHL, Cochrane Library, and clinicaltrials. gov to identify eligible studies reporting the clinical outcomes of patients with CRAB infections. The meta-analysis employed a random-effects model to estimate the odds ratio (OR) and standardized mean difference (SMD) with 95% confidence interval (CI). The primary outcome was 1-month mortality for any cause. We also examined clinical response, microbiological response, length of stay in hospital, and adverse events.Results: Eleven eligible studies were analyzed (1052 patients in total), including 2 randomized clinical trials. Serious risk of bias was found in 8 out of the 11 studies. There was no statistically significant difference between polymyxins based therapies and non-polymyxins based therapies in 1-month mortality for any cause (OR, 0.95; 95% CI, 0.59 to 1.53), microbiological response (OR, 3.83; 95% CI, 0.90 to 16.29) and length of stay in hospital (SMD, 0.24; 95% CI, − 0.08 to 0.56). The pooled OR of clinical response indicated a significant difference in favor of polymyxin based therapies (OR, 1.99; 95% CI, 1.31 to 3.03). The pooled OR of adverse events showed that non-polymyxins based therapies were associated with fewer adverse events (OR, 4.32; 95% CI, 1.39 to 13.48).

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis

et al. 2020

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Treatment of patients with serious infections due to carbapenem‐resistant Acinetobacter baumannii: How viable are the current options?

2021

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This review critically appraises the published microbiologic and clinical data on the treatment of patients with carbapenem‐resistant Acinetobacter baumannii infections. Despite being recognized as an urgent threat pathogen by the CDC and WHO, optimal treatment of patients with serious CRAB infections remains ill‐defined. Few commercially available agents exhibit reliable in vitro activity against CRAB. Historically, polymyxins have been the most active agents in vitro, though interpretations of susceptibility data are difficult given issues surrounding MIC testing methodologies and lack of correlation between MICs and clinical outcomes. Most available preclinical and clinical data involve use of polymyxins, tetracyclines, and sulbactam, alone and in combination. As the number of viable treatment options is limited, combination therapy with a polymyxin is often used for patients with CRAB infections, despite the significant risk of nephrotoxicity. However, no treatment regimen has been found to reduce mortality, which exceeds 40% across most studies, or substantially improve clinical response. While some newer agents, such as eravacycline and cefiderocol, have demonstrated in vitro activity, clinical efficacy has not been fully established. New agents with clinically relevant activity against CRAB isolates and favorable toxicity profiles are sorely needed.

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Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study

Hu,

Li,

Zhang

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose Post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria (CRGNB) is a life-threatening complication. This study aimed to assess the current practices and clinical outcomes of intravenous (IV) combined with intraventricular (IVT)/intrathecal (ITH) polymyxin B in treating CRGNB intracranial infection. Methods A retrospective study was conducted on patients with post-neurosurgical intracranial infection due to CRGNB from January 2013 to December 2020. Clinical characteristics and treatment outcomes were collected and described. Kaplan–Meier survival and multivariate logistic regression analyses were performed. Results The study included 114 patients, of which 72 received systemic antimicrobial therapy combined with IVT/ITH polymyxin B, and 42 received IV administration alone. Most infections were caused by carbapenem-resistant Acinetobacter baumannii (CRAB, 63.2%), followed by carbapenem-resistant Klebsiella pneumoniae (CRKP, 31.6%). Compared with the IV group, the IVT/ITH group had a higher cerebrospinal fluid (CSF) sterilization rate in 7 days (p < 0.001) and lower 30-day mortality (p = 0.032). In the IVT/ITH group, patients with CRKP infection had a higher initial fever (p = 0.014), higher incidence of bloodstream infection (p = 0.040), lower CSF sterilization in 7 days (p < 0.001), and higher 30-day mortality (p = 0.005) than those with CRAB infection. Multivariate logistic regression analysis revealed that the duration of IVT/ITH polymyxin B (p = 0.021) was independently associated with 30-day mortality. Conclusions Intravenous combined with IVT/ITH polymyxin B increased CSF microbiological eradication and improved clinical outcomes. CRKP intracranial infections may lead to more difficult treatment and thus warrant attention and further optimized treatment.

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Efficacy of intravenous plus intrathecal/intracerebral ventricle injection of polymyxin B for post-neurosurgical intracranial infections due to MDR/XDR Acinectobacter baumannii: a retrospective cohort study

Cited by 47 publications

References 36 publications

Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis

Clinical efficacy and safety of polymyxins based versus non-polymyxins based therapies in the infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review and meta-analysis

Treatment of patients with serious infections due to carbapenem‐resistant Acinetobacter baumannii: How viable are the current options?

Intraventricular or intrathecal polymyxin B for treatment of post-neurosurgical intracranial infection caused by carbapenem-resistant gram-negative bacteria: a 8-year retrospective study

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