Abstract
BackgroundHigh morbidity and mortality due to carbapenem-resistant Gram-negative bacilli (CR-GNB) has led to the resurgence of polymyxin B (PMB) use in the last decade. The aim of our multicenter, real-world study was to evaluate the effectiveness and safety of PMB in the treatment of CR-GNB infections.MethodsThe real-world study included patients treated with intravenous PMB for at least 7 days during the period of October 2018 through June 2019. Associations between these clinical features and 28-day mortality or all-cause hospital mortality were explored through univariate analyses and multivariable logistic regression.ResultsThe study included 100 patients. Many patients presented with combined chronic conditions, septic shock, mechanical ventilation, and the presence of Klebsiella pneumoniae. The mean duration of PMB therapy was 11 days (range 7–38 days). Temperature (38 °C vs 37.1 °C), white blood cells (14.13 × 109/l vs 9.28 × 109/l), C-reactive protein (103.55 ug/l vs 47.60 ug/l), procalcitonin (3.89 ng/ml vs 1.70 ng/ml) and APACHE II levels (17.75 ± 7.69 vs 15.98 ± 7.95) were significantly decreased after PMB treatment. The bacteria eradication rate was 77.65%. The overall mortality at discharge was 15%, and 28-day mortality was 40%. Major adverse reactions occurred in 16 patients. Nephrotoxicity was observed in 7 patients (7%).ConclusionsOur results provide positive clinical and safety outcomes for PMB in the treatment of CR-GNB. Timely and appropriate use of PMB may be particularly useful in treating patients with sepsis in CR-GNB infections.
Highlights
In recent years, infections due to carbapenem-resistant Gram-negative bacilli (CR-GNB) have become an increasingly important cause of mortality and morbidity around the world [1]
Physicians have sought solutions in the arsenal of older therapeutics. This has led to the re-introduction of polymyxins in the treatment of infections caused by CRGNB, as polymyxins are one of the few antibiotics that remain effective against these organisms [3]
Age Male (%) Intensive care unit (ICU) admission, n (%) Mechanical ventilation, n (%) Chronic medical conditions, n (%) Heart disease Hypertension Stroke Cancer Diabetes mellitus Chronic obstructive pulmonary disease Renal insufficiency, n (%) Septic shock, n (%) Sequential Organ Failure Assessment (SOFA) score, mean ± SD APACHE II, mean ± SD ICU stay before intravenous polymyxin B (PMB), days, median (IQR) multiple organ dysfunction syndrome (MODS), n (%) PCT, ng/ml, median (IQR) Bacterial, n (%) AB KP PA Other Unknown Infection sites, n (%) BSI Pulmonary infection Intraperitoneal infection Incision infection Others Concomitant antibiotic therapy PMB + Carbapenem PMB + Carbapenem + Tigecycline PMB + Tigecycline PMB + Cephalosporin PMB + Carbapenem + Cephalosporin Others Daily dose of PMB, mg/day, n (%) 100 150 200
Summary
Infections due to carbapenem-resistant Gram-negative bacilli (CR-GNB) have become an increasingly important cause of mortality and morbidity around the world [1]. Physicians have sought solutions in the arsenal of older therapeutics This has led to the re-introduction of polymyxins in the treatment of infections caused by CRGNB, as polymyxins are one of the few antibiotics that remain effective against these organisms [3]. Due to multiple drug resistance among Gram-negative bacilli, physicians have been increasingly forced to rely on polymyxins for the treatment of infections caused by these pathogens. It has not been determined which of these agents is superior in terms of the cure rate or microbiological resolution [15, 16]. The aim of our multicenter, real-world study was to evaluate the effectiveness and safety of PMB in the treatment of CR-GNB infections
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