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. Metho...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08339-0 |
| _version_ | 1797818151716519936 |
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| author | Jiale Wang Binay Kumar Shah Jian Zhao Jie Xiong Changhui Wang Shuanshuan Xie |
| author_facet | Jiale Wang Binay Kumar Shah Jian Zhao Jie Xiong Changhui Wang Shuanshuan Xie |
| author_sort | Jiale Wang |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-13T09:03:45Z |
| format | Article |
| id | doaj.art-84e26773e70c491599cf32e75646ebdc |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-13T09:03:45Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-84e26773e70c491599cf32e75646ebdc2023-05-28T11:09:27ZengBMCBMC Infectious Diseases1471-23342023-05-0123111110.1186/s12879-023-08339-0Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNBJiale Wang0Binay Kumar Shah1Jian Zhao2Jie Xiong3Changhui Wang4Shuanshuan Xie5Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of Emergency Medicine, Shanghai Tenth People‘S Hospital, Tongji University School of MedicineDepartment of Respiratory Medicine, ChongMing Branch of Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of MedicineDepartment of Respiratory Medicine, Shanghai Tenth People’s Hospital, Tongji University School of MedicineAbstract 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.https://doi.org/10.1186/s12879-023-08339-0Colistin sulfatePolymyxin BCR-GNBClinical successMicrobial success |
| spellingShingle | Jiale Wang Binay Kumar Shah Jian Zhao Jie Xiong Changhui Wang Shuanshuan Xie Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB BMC Infectious Diseases Colistin sulfate Polymyxin B CR-GNB Clinical success Microbial success |
| title | Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB |
| title_full | Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB |
| title_fullStr | Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB |
| title_full_unstemmed | Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB |
| title_short | Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB |
| title_sort | comparative study of polymyxin b and colistin sulfate in the treatment of severe comorbid patients infected with cr gnb |
| topic | Colistin sulfate Polymyxin B CR-GNB Clinical success Microbial success |
| url | https://doi.org/10.1186/s12879-023-08339-0 |
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