Epidemiology and outcome of infections with carbapenem-resistant Gram-negative bacteria treated with polymyxin B-based combination therapy

Crusio, Robbert; Rao, Sriharsha; Changawala, Nisarg; Paul, Vishesh; Tiu, Ceres T.; Ginkel, Joost van; Chapnick, Edward K.; Kupfer, Yizhak

doi:10.3109/00365548.2013.844350

Cited by 34 publications

(30 citation statements)

References 36 publications

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“…One study, which employed colistin combinations in Gram-negative infections, found no difference between treatment regimens, but found mortality was significantly associated with age, CCI score and severity of acute disease. [28] Similar to the present study, other researchers have found higher mortality in patients with malignancy and chronic renal damage. [4] Colistin-related nephrotoxicity rates varying between 0 and 33% have been reported in previous studies.…”

Section: Discussionsupporting

confidence: 91%

Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

et al. 2015

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Objective. To investigate whether there was a difference in mortality, clinical response and bacterial eradication between colistin monotherapy and colistin combination therapies for the treatment of nosocomial pneumonia/ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in a medical intensive care unit (ICU). Methods. This retrospective, observational and single-centre study included all patients who were in the medical ICU of Gazi University Medical Faculty Hospital and diagnosed with nosocomial pneumonia/VAP caused by A. baumannii between January 2009 and September 2014. Results. The median age of the 134 patients was 68 years and 53.3% were male. The most common causes of admission were respiratory insufficiency (66.7%) and sepsis/septic shock (54.8%). In patients with nosocomial pneumonia/VAP caused by A. baumannii, on median day 5 of admission, colistin monotherapy was used in 23 (21.6%) patients, a carbapenem combination was used in 80 (59.7%) patients, sulbactam-ampicillin combination was used in 42 (31.4%) patients, tigecycline combination was used in 26 (19.4%) patients, and sulbactam-cefoperazone combination was used in 17 (12.7%) patients. Median ICU stay of the patients was 15.5 days, and 112 (83.6%) patients died. Colistin monotherapy and combination therapies had no superiority over each other in clinical response for the treatment of A. baumannii-associated nosocomial pneumonia/VAP. Mortality was found to be higher in patients receiving the colistin-carbapenem combination (64.3% v. 36.4%, p=0.016). Discharge/day-of-death Sequential Organ Failure Assessment score (odds ratio (OR) 2.017, 95% confidence interval (CI) 1.330 -3.061) and vasopressor use (OR 9.014, 95% CI 1.360 -59.464) were independent risk factors for ICU mortality. Conclusion. Colistin monotherapy and combination therapies have no superiority over each other for clinical response in the treatment of nosocomial pneumonia/VAP caused by multidrug-resistant A. baumannii. Colistin-SAM was associated with improved microbiological eradication and colistin-carbapenem combination was associated with increased mortality.S Afr J Crit Care 2015;31(2):51-58.

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Section: Discussionsupporting

confidence: 91%

Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

et al. 2015

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“…Large, prospective, randomized trials are necessary to establish the benefits with optimal dosage selection [38]. In an observational cohort study, Crusio et al [45] evaluated different polymyxin B combination therapies in carbapenem-resistant Gram-negative bacteria. Different infections included A. baumannii ( n = 34/104), K. pneumoniae ( n = 25/104), P. aeruginosa ( n = 11/104), and multiple organisms ( n = 34/105).…”

Section: Efficacy Of Polymyxin B: Combination Therapymentioning

confidence: 99%

Resurgence of Polymyxin B for MDR/XDR Gram-Negative Infections: An Overview of Current Evidence

Garg

Singh

Juneja

et al. 2017

Critical Care Research and Practice

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“…A study including 104 patients with carbapenem-resistant (CR) bacterial infection indicated polymyxin B combination therapy with all-cause mortality of 47% during hospitalization and 77% after 6 months (46). Is combination therapy better than monotherapy?…”

Section: Combination Therapymentioning

confidence: 99%

“…Toxicities associated with colistin do not appear to increase with use of a loading dose (38,46). Limited clinical evidence is available.…”

Section: Loading Dosesmentioning

confidence: 99%

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Intravenous polymyxins: Revival with puzzle

Fei

et al. 2017

BST

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Epidemiology and outcome of infections with carbapenem-resistant Gram-negative bacteria treated with polymyxin B-based combination therapy

Abstract: CRGNB infections are associated with previous antibiotic and health care exposure. Mortality is related to age and the severity of chronic and acute illness.

Cited by 34 publications

References 36 publications

Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

Resurgence of Polymyxin B for MDR/XDR Gram-Negative Infections: An Overview of Current Evidence

Intravenous polymyxins: Revival with puzzle

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