Comparative study of colistin Methanesulfonate and colistin Sulfate/polymyxin B in the treatment of ceftazidime-avibactam resistant Gram-negative bacilli infections

Abstract

ObjectiveTo evaluate the clinical efficacy of different species of polymyxin drugs in the treatment of Carbapenem-Resistant Gram-negative bacilli (CR-GNB) resistant to ceftazidime-avibactam (CZA). MethodsPatients infected by CR-GNB strains and treated with polymyxin drugs were selected and divided into colistin methanesulfonate (CMS) group and colistin sulfate/polymyxin B (CSPB) group to observe clinical efficacy and safety. Results65 patients were eventually included (CMS group, n ​= ​29; CSPB group, n ​= ​36). The clinical efficacy, microbiological eradication rate and 28-day mortality between the two groups were similar, with no statistical significance (51.72 ​% vs. 50.00 ​%, p ​= ​0.890; 55.17 ​% vs. 52.78 ​%, p ​= ​0.847; 17.24 ​% vs. 25.00 ​%, p ​= ​0.449). With regard to renal safety, the incidence of acute kidney injury (AKI) in the CMS group was significantly higher than that in the CSPB group (34.48 ​% vs. 5.56 ​%, p ​= ​0.003). Among them, the incidence of AKI grade 3 in the CMS group tended to be higher than that in the CSPB group (24.14 ​% vs. 5.56 ​%, p ​= ​0.066). ConclusionThe results based on small sample size from a single center showed that clinical response to the treatment of ceftazidime-avibactam resistant Gram-negative bacillus infections is similar for CMS and Colistin Sulfate/Polymyxin B, but the nephrotoxicity of CMS is greater than that of polymyxin sulfates.