| Efficacy of polymyxin B in septic patients infected with extensively drug-resistant Gram-negative bacteria |
| Received:October 26, 2020 Revised:November 30, 2020 Click here to download the full text |
| Citation of this paper:HE Hong-yu,WU Xue-fei,JU Min-jie,LIU Yi-mei,GU Zhun-yong,LIU Wen-jun,SU Ying,LUO Zhe.Efficacy of polymyxin B in septic patients infected with extensively drug-resistant Gram-negative bacteria[J].Chinese Journal of Clinical Medicine,2021,28(2):241-247 |
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| Author Name | Affiliation | E-mail | | HE Hong-yu | Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | WU Xue-fei | Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | JU Min-jie | Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | LIU Yi-mei | Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | GU Zhun-yong | Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | LIU Wen-jun | Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | SU Ying | Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China | | | LUO Zhe | Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China | luo.zhe@zs-hospital.sh.cn |
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| Abstract:Objective: To investigate the clinical efficacy and safety of polymyxin B in septic patients infected with extensively drug-resistant (XDR) Gram-negative bacteria. Methods: Retrospective data were collected in 30 septic patients with XDR Gram-negative bacterial infection treated with polymyxin B in the intensive care unit from August 2018 to July 2019. Patients’ clinical characteristics, bacterial location and type, the total dose and duration of polymyxin B, early or delayed administration of polymyxin B (within or after 48 hours on XDR bacterial were observed) were recorded. The primary endpoint was ICU mortality. Results: Of the 30 septic patients, 24 (80%) were male, with a mean age of (66.7±18.9) years. All patients received polymyxin B treatment. 11 patients infected with Klebsiella pneumonia, 11 patients infected with Acinetobacter baumannii, 3 patients infected with Pseudomonas aeruginosa, and 5 patients infected with mixed resistant bacteria. The infection sites were bloodstream (13 cases), pulmonary (14 cases), and catheter (3 cases). The median duration of polymyxin B was 8 days, the median cumulative dose was 1 115.0 mg. 14 patients (46.6%) initiated polymyxin B within 48 hours. After the treatment of polymyxin B, the clearance rate (76.9%) of microorganisms in bloodstream was significantly higher than that in pulmonary (7.1%) and catheter (66.7%; P=0.001). ICU mortality rate was 60.0% (18/30). Multivariate analyses showed that sequential organ failure assessment (SOFA) score (OR=1.434,95% CI 1.017-2.022,P=0.040) and delayed initiation of polymyxin B (OR=12.950,95% CI 1.487-112.770, P=0.020) were closely related to ICU death. Moreover, 36.7% of patients with polymyxin B had chronic renal insufficiency, and after treatment of polymyxin B, the proportion of acute kidney injury (AKI) increased to 70.0% (χ2=4.27, P=0.039). Conclusions: Delayed use of polymyxin B-based combination therapy is associated with poor prognosis of septic patients with XDR Gram-negative bacteria. Nephrotoxicity prevalence should be closely monitored in patients treated with polymyxin B. |
| keywords:polymyxin B sepsis extensively drug-resistant Gram-negative bacteria |
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