Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB.

Abstract

BACKGROUND:

With the difficulties in choosing colistin sulfate and polymyxin B sulfate (PBS) for carbapenem-resistant gram-negative bacteria (CR-GNB), we compared the efficacy and safety of these two old polymyxins in treatment of critically ill patients infected with CR-GNB infection.

METHODS:

One hundred four patients infected with CR-GNB in ICU were retrospectively grouped by PBS (68 patients) or colistin sulfate (36 patients). Clinical efficacy including symptoms, inflammatory parameters, defervescence, prognosis and microbial efficacy were analyzed. Hepatotoxicity, nephrotoxicity, and hematotoxicity were evaluated by TBiL, ALT, AST, creatinine, and thrombocytes.

RESULTS:

Demographic characteristics between colistin sulfate and PBS were not significantly different. Most of the CR-GNB were cultured in respiratory tract (91.7% vs 86.8%), and almost all were polymyxin-sensitive (98.2% vs 100%, MIC ≤ 2 μg/ml). The microbial efficacy in colistin sulfate (57.1%) was significantly higher than PBS (30.8%) (p = 0.022), however, no significant difference in clinical success was seen in both groups (33.8% vs 41.7%), as well as mortality, defervescence, imaging remission, days in the hospital, microbial reinfections, and prognosis, and almost all patients defervesce within 7 days (95.6% vs 89.5%).

CONCLUSIONS:

Both polymyxins can be administrated in critically ill patients infected with CR-GNB and colistin sulfate is superior to PBS in microbial clearance. These results highlight the necessity of identifying CR-GNB patients who may benefit from polymyxin and who are at higher risk of mortality.

• Authors: Jiale Wang, Binay Kumar Shah, Jian Zhao, Jie Xiong, Changhui Wang, Shuanshuan Xie
• Journal: BMC infectious diseases (BMC Infect Dis) Vol. 23 Issue 1 Pg. 351 (May 25 2023) ISSN: 1471-2334 [Electronic] England
• PMID: 37231342 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s).

Chemical References

• Colistin
• Polymyxin B
• Anti-Bacterial Agents
• Carbapenems
• Polymyxins

Topics

• Humans
• Colistin (adverse effects)
• Polymyxin B (adverse effects)
• Anti-Bacterial Agents (therapeutic use)
• Carbapenems (therapeutic use)
• Retrospective Studies
• Critical Illness
• Gram-Negative Bacteria
• Polymyxins (therapeutic use)
• Gram-Negative Bacterial Infections (drug therapy, microbiology)