Polymyxin B Nephrotoxicity and Efficacy against Nosocomial Infections Caused by Multiresistant Gram-Negative Bacteria

Abstract

Reported rates of nephrotoxicity associated with the systemic use of polymyxins have varied widely. The emergence of infections due to multiresistant gram-negative bacteria has necessitated the use of systemic polymyxin B once again for the treatment of such infections. We retrospectively investigated the rate of nephrotoxicity in patients receiving polymyxin B parenterally for the treatment of infections caused by multiresistant gram-negative bacteria from October 1999 to September 2000. Demographic and clinical information was obtained for 60 patients. Outcome measures of interest were renal toxicity and clinical and microbiologic efficacy. Renal failure developed in 14% of the patients, all of whom had normal baseline renal function. Development of renal failure was independent of the daily and cumulative doses of polymyxin B and the length of treatment but was significantly associated with older age (76 versus 59 years, P ‫؍‬ 0.02). The overall mortality was 20%, but it increased to 57% in those who developed renal failure. The organism was cleared in 88% of the patients from whom repeat specimens were obtained. The use of polymyxin B to treat multiresistant gram-negative infections was highly effective and associated with a lower rate of nephrotoxicity than previously described.

Intravenous Colistin Use for Multidrug-Resistant Gram-Negative Infections in Pediatric Patients

“…In previous reports, nephrotoxicity was the most common adverse effect of colistin therapy (18,20,24); however, recent studies reported lower nephrotoxicity rates in association with colistin use (14,27). In our study, we observed nephrotoxicity only in one patient which is similar to report of Falagas et al (27) in 2009.…”

“…Few studies have investigated the clinical efficacy and safety of colistin use in children. It has been reported in previous studies that the effectiveness rates with colistin therapy were 47-88% (15,(18)(19)(20).…”

The Use of Intravenous and Aerosolized Polymyxins for the Treatment of Infections in Critically Ill Patients: A Review of the Recent Literature

“…Thus, definite statements regarding the effectiveness of intravenous polymyxins as monotherapy cannot be made. [31][32][33] In a comparative observational study of intravenous colistimethate sodium versus intravenous meropenem for the treatment of intensive care unit patients with Acinetobacter baumannii ventilator-associated pneumonia, the observed outcomes, including in-hospital mortality, ventilator-associated pneumonia-related mortality and clinical cure, were comparable. 34 …”

Factores asociados a nefrotoxicidad por polimixina B en un hospital universitario de Neiva, Colombia. 2011-2015

“…No obstante, en la última década, ante el surgimiento y alta tasa de mortalidad en infecciones invasoras causadas por BGN-MR, polimixina B, en monoterapia o en combinación con otros antimicrobianos activos contra BGN-MR, permanece como el principal antimicrobiano usado para agentes de este tipo en nuestro medio 1,7,8 . Históricamente, la falla renal asociada al uso de polimixina B fluctúa entre 14 y 60% [8][9][10][11][12][13] . No obstante, estudios 8 www.sochinf.cl…”