Infectious Diseases: Parenteral Polymyxin B Use in Patients with Multidrug-Resistant Gram-Negative Bacteremia and Urinary Tract Infections: A Retrospective Case Series

Pastewski, Andrew; Caruso, Patricia; Parris, Addison R; Dizon, Ramon; Kopec, Robert; Sharma, Shobha; Mayer, Suri; Ghitan, Monica; Chapnick, Edward K.

doi:10.1345/aph.1k346

Cited by 39 publications

(20 citation statements)

References 27 publications

(38 reference statements)

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“…Other independent risk factors identified include age and duration of therapy for colistin and duration of therapy only for polymyxin B. Our findings are consistent with the risk factors identified in previous studies (8,22,29). Colistin-associated nephrotoxicity was well explained by the independent risk factors (as reflected in a receiver operating characteristic area under the curve of Ͼ0.85), resulting in a high degree of concordance using the identified risk factors.…”

Section: Discussionsupporting

confidence: 90%

In Vitro Assessment and Multicenter Cohort Study of Comparative Nephrotoxicity Rates Associated with Colistimethate versus Polymyxin B Therapy

Phe

Lee

McDaneld

et al. 2014

Antimicrob Agents Chemother

164

154

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Despite concerns of nephrotoxicity, polymyxin antibiotics often remain the only susceptible agents for multidrug-resistant (MDR) Gram-negative bacteria. Colistin has been more commonly used clinically due to a perceived safety benefit. We compared the nephrotoxicity of colistin to polymyxin B. The in vitro cytotoxicity of colistin was compared to polymyxin B in two mammalian renal cell lines. To validate the clinical relevance of the findings, we evaluated adult patients with normal renal function who received a minimum of 72 h of polymyxin therapy in a multicenter study. The primary outcome was the prevalence of nephrotoxicity, as defined by the RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria. Colistin exhibited an in vitro cytotoxicity profile similar to polymyxin B. A total of 225 patients (121 receiving colistimethate, 104 receiving polymyxin B) were evaluated. Independent risk factors for colistimethate-associated nephrotoxicity included age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.00 to 1.07; P ‫؍‬ 0.03), duration of therapy (OR 1.08; 95% CI, 1.02 to 1.15; P ‫؍‬ 0.02), and daily dose by ideal body weight (OR 1.40; 95% CI, 1.05 to 1.88; P ‫؍‬ 0.02). In contrast, cystic fibrosis was found to be a protective factor in patients who received colistimethate (OR, 0.03; 95% CI, 0.001 to 0.79; P ‫؍‬ 0.04). In a matched analysis based on the risk factors identified (n ‫؍‬ 76), the prevalence of nephrotoxicity was higher with colistimethate than with polymyxin B (55.3% versus 21.1%; P ‫؍‬ 0.004). Polymyxin B was not found to be more nephrotoxic than colistin and may be the preferred polymyxin for MDR infections. A prospective study comparing the two polymyxins directly is warranted.

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Section: Discussionsupporting

confidence: 90%

In Vitro Assessment and Multicenter Cohort Study of Comparative Nephrotoxicity Rates Associated with Colistimethate versus Polymyxin B Therapy

Phe

Lee

McDaneld

et al. 2014

Antimicrob Agents Chemother

164

154

View full text Add to dashboard Cite

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“…Two polymyxins, namely, polymyxin B and polymyxin E (synonym, colistin), have been available clinically since the late 1950s but were abandoned in the 1970s due to their potential for nephrotoxicity (5,6). There is little doubt that there is an association between polymyxin therapy and nephrotoxicity (7)(8)(9), and recent clinical studies have shown that the incidence rate is up to 60%, depending on the definition of nephrotoxicity (7,(10)(11)(12). Unfortunately, the mechanism(s) of polymyxin-induced nephrotoxicity is not clear (13).…”

mentioning

confidence: 99%

Polymyxin B Induces Apoptosis in Kidney Proximal Tubular Cells

Azad

Finnin

Poudyal

et al. 2013

Antimicrob Agents Chemother

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“…Evaluations of polymyxin B (20) and tigecycline (2,8,10,14,21) for the treatment of Gram-negative bacterial UTI are limited to case reports. In addition to limited clinical data, pharmacokinetic data raise concerns over the use of polymyxin B and tigecycline for UTI.…”

mentioning

confidence: 99%

Comparative Effectiveness of Aminoglycosides, Polymyxin B, and Tigecycline for Clearance of Carbapenem-Resistant Klebsiella pneumoniae from Urine

Satlin

Kubin

Blumenthal

et al. 2011

Antimicrob Agents Chemother

118

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Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasingly common cause of health careassociated urinary tract infections. Antimicrobials with in vitro activity against CRKP are typically limited to polymyxins, tigecycline, and often, aminoglycosides. We conducted a retrospective cohort study of cases of CRKP bacteriuria at New York-Presbyterian Hospital from January 2005 through June 2010 to compare microbiologic clearance rates based on the use of polymyxin B, tigecycline, or an aminoglycoside. We constructed three active antimicrobial cohorts based on the active agent used and an untreated cohort of cases that did not receive antimicrobial therapy with Gram-negative activity. Microbiologic clearance was defined as having a follow-up urine culture that did not yield CRKP. Cases without an appropriate follow-up culture or that received multiple active agents or less than 3 days of the active agent were excluded. Eighty-seven cases were included in the active antimicrobial cohorts, and 69 were included in the untreated cohort. The microbiologic clearance rate was 88% in the aminoglycoside cohort (n ‫؍‬ 41), compared to 64% in the polymyxin B (P ‫؍‬ 0.02; n ‫؍‬ 25), 43% in the tigecycline (P < 0.001; n ‫؍‬ 21), and 36% in the untreated (P < 0.001; n ‫؍‬ 69) cohorts. Using multivariate analysis, the odds of clearance were lower for the polymyxin B (odds ratio [OR], 0.10; P ‫؍‬ 0.003), tigecycline (OR, 0.08; P ‫؍‬ 0.001), and untreated (OR, 0.14; P ‫؍‬ 0.003) cohorts than for the aminoglycoside cohort. Treatment with an aminoglycoside, when active in vitro, was associated with a significantly higher rate of microbiologic clearance of CRKP bacteriuria than treatment with either polymyxin B or tigecycline.

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Infectious Diseases: Parenteral Polymyxin B Use in Patients with Multidrug-Resistant Gram-Negative Bacteremia and Urinary Tract Infections: A Retrospective Case Series

Abstract: Our data suggest that polymyxin B may be effective for MDR gram-negative infections in patients with limited therapeutic options, but precautions should be taken to avoid toxicity.

Cited by 39 publications

References 27 publications

In Vitro Assessment and Multicenter Cohort Study of Comparative Nephrotoxicity Rates Associated with Colistimethate versus Polymyxin B Therapy

In Vitro Assessment and Multicenter Cohort Study of Comparative Nephrotoxicity Rates Associated with Colistimethate versus Polymyxin B Therapy

Polymyxin B Induces Apoptosis in Kidney Proximal Tubular Cells

Comparative Effectiveness of Aminoglycosides, Polymyxin B, and Tigecycline for Clearance of Carbapenem-Resistant Klebsiella pneumoniae from Urine

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