Intravenous polymyxins: Revival with puzzle

Yu, Yun; Fei, Aihua; Wu, Zengbin; Gao, Chengjin; Pan, Shuming

doi:10.5582/bst.2017.01188

Cited by 10 publications

(8 citation statements)

References 108 publications

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“…13 Finally, in cases with undetermined responses, it was not possi- for efficacious antibacterial effect. 13 Finally, in cases with undetermined responses, it was not possi- for efficacious antibacterial effect.…”

Section: Discussionmentioning

confidence: 99%

“…The major risk factors associated with treatment failure include the inadequate antimicrobial spectrum of the prescribed antibiotic and the lack of or insufficient control of the source of infection. 13 Ismail and colleagues conducted a study to identify predictors of treatment failure among critically ill patients treated with polymyxin B and concluded that a short duration of polymyxin B therapy was associated with treatment failure. 14 In our study, treatment failure was observed in 15 patients (6.1%).…”

Section: Discussionmentioning

confidence: 99%

“…Inappropriate coverage is most likely the major cause of ATF. 13 Finally, in cases with undetermined responses, it was not possi- for efficacious antibacterial effect. If the dose of polymyxin B is reduced because of acute kidney impairment, the plasma polymyxin B concentration will decline and potentially impact its antibacterial effects.…”

Section: Discussionmentioning

confidence: 99%

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Polymyxin B clinical outcomes: A prospective study of patients undergoing intravenous treatment

et al. 2019

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Summary What is known and objective Polymyxins, especially polymyxin B, has become the last line of therapy against Gram‐negative pathogens’ carbapenemase producers. However, given increasing use of polymyxin B in clinical settings its therapeutic value has been evaluated worldwide due to its toxic effects. The aim of this study was to assess the efficacy and safety of antimicrobial therapy with polymyxin B in patients with multidrug‐resistant bacteria in Brazil. Methods This was a prospective cohort study in a 403‐bed academic tertiary care centre, located in the countryside of Brazil. Patients receiving polymyxin B intravenous treatment for at least 72 hours were eligible for the study. Antimicrobial susceptibility, adverse reactions and clinical outcomes were submitted for descriptive analysis. Main outcomes measure the following: Patients' conditions following treatment (Treatment Success, Mortality, Treatment Failure, Inadequate Empiric Treatment or Indeterminate Response) and toxicities induced by polymyxin B (nephrotoxicity and skin hyperpigmentation). Results and discussion Among 247 patients, treatment success was achieved in 25.1%, while mortality was observed in 32.8%. Empirical therapy was prescribed for 26.3% of the patients. Nephrotoxicity was reported in 40.5%. The carbapenemase producer, Klebsiella pneumonia, was the bacterium most associated with mortality (22.2%). Conclusions Even though polymyxin B is currently the main therapy against carbapenemase producers, its use demands robust criteria to lead to positive clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Polymyxin B clinical outcomes: A prospective study of patients undergoing intravenous treatment

et al. 2019

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“…There is no consensus in the literature as to the best polymyxin regimen for each bacterial species, and the exact molecular mechanisms of combination therapy are not known. The supposition that combination therapy is superior needs to be tested in controlled studies [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…mechanisms of combination therapy are not known. The supposition that combination therapy is superior needs to be tested in controlled studies [21,22].…”

Section: Plos Onementioning

confidence: 99%

Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance

et al. 2020

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Objectives To analyse the use of polymyxins for the treatment of ventilator-associated pneumonia (VAP) at a teaching hospital where carbapenem-resistant gram-negative bacteria are endemic. Patients and methods This was a historical cohort study of patients receiving polymyxins to treat VAP in ICUs at a public university hospital in southern Brazil between January 1, 2017 and January 31, 2018. Results During the study period, 179 cases of VAP were treated with polymyxins. Of the 179 patients, 158 (88.3%) were classified as having chronic critical illness. Death occurred in 145 cases (81.0%). Multivariate analysis showed that the factors independently associated with mortality were the presence of comorbidities (P<0.001) and the SOFA score of the day of polymyxin prescription (P<0.001). Being a burn patient was a protective factor for mortality (P<0.001). Analysis of the 14-day survival probability showed that mortality was higher among the patients who had sepsis or septic shock at the time of polymyxin prescription (P = 0.028 and P<0.001, respectively). Acinetobacter baumannii was identified as the etiological agent of VAP in 121 cases (67.6%). In our cohort, polymyxin consumption and the incidence density of VAP were quite high.

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Rate of polymyxin resistance among Acinetobacter baumannii recovered from hospitalized patients: a systematic review and meta-analysis

Lima

Brito

Cardoso

et al. 2020

Eur J Clin Microbiol Infect Dis

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Intravenous polymyxins: Revival with puzzle

Cited by 10 publications

References 108 publications

Polymyxin B clinical outcomes: A prospective study of patients undergoing intravenous treatment

Polymyxin B clinical outcomes: A prospective study of patients undergoing intravenous treatment

Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance

Rate of polymyxin resistance among Acinetobacter baumannii recovered from hospitalized patients: a systematic review and meta-analysis

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