scholarly journals A Real-World Study for Polymyxin B in the Treatment of Carbapenems Resistant Gram-Negative Bacilli

2020 ◽  
Author(s):  
Xiaojuan Zhang ◽  
Shaoyan Qi ◽  
Xiaoguang Duan ◽  
Bing Han ◽  
Shuguang Zhang ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Real World ◽  
Positive Impact ◽  
Polymyxin B ◽  
High Morbidity ◽  
Therapeutic Effects ◽  
Gram Negative ◽  
Carbapenem Resistant

Abstract Background: High morbidity and mortality due to carbapenem-resistant Gram-negative bacilli (CRGNB) was a challenge for clinicians has led to the resurgence of polymyxin B (PMB) use in the last decade. The goal of our multicenter, real-world study was to evaluate the efficacy and safety of PMB in the treatment of CRGNB.Methods: The real-world study included the patients with intravenous PMB at least 7 days during the period of October 2018 to June 2019. Data was collected from electronic patients register and follow-up. The primary outcome was 28-day mortality, the secondary outcomes included hospital mortality, occurrence of adverse events during PMB therapy. Associations between these variables and 28-day mortality or all-cause hospital mortality were explored through univariate analyses and multivariable logistic regression. At the same time, therapeutic effects were observed. Results: The study included 100 patients. There were 39% presence of septic shock, 49% need mechanical ventilation at the beginning of therapy. The infection and condition improved after 7 days of PMB treatment. The major adverse reactions occurred in 16 cases (16%). The overall 28-day mortality was 40%. In terms of clinical characteristics, mean Sequential Organ Failure Assessment (6.77 versus 9.25，P = 0.004)，mean Acute Physiology and Chronic Health Evaluation II (APACHEII) scores (16.17 versus 19.78, P = 0.016) and the number of patient with mechanical ventilation (21 versus 30, P = 0.000) or septic shock (17 versus 32, P = 0.000) were lower in survivors group than nonsurvivors group. The mortality of 85 patients with identify pathogens was 38.82%, while the mortality of patients with negative pathogen culture results was 46.67% (P = 0.580). Multivariate analysis showed that mechanical ventilation (P = 0.023, OR = 3.5; CI: 1.194–10.739), septic shock (P = 0.002, OR = 5.960; CI: 1.923–18.473) were associated with 28-day mortality.Conclusion: Our research found that PMB may be as effective and safe as standard antibiotics for the treatment of CRGNB. Timely and appropriate use of PMB will have a positive impact on the clinical outcomes of patients with sepsis in CRGNB.

scholarly journals Clinical outcomes and safety of polymyxin B in the treatment of carbapenem-resistant Gram-negative bacterial infections: a real-world multicenter study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xiaojuan Zhang ◽  
Shaoyan Qi ◽  
Xiaoguang Duan ◽  
Bing Han ◽  
Shuguang Zhang ◽  
...  
Keyword(s):  
Real World ◽  
Bacterial Infections ◽  
White Blood Cells ◽  
Polymyxin B ◽  
High Morbidity ◽  
Gram Negative ◽  
Reactive Protein ◽  
Carbapenem Resistant ◽  
The Mean ◽  
Univariate Analyses

Abstract Background High 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. Methods The 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. Results The 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%). Conclusions Our 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.

scholarly journals Clinical Outcomes and Safety of Polymyxin B in the Treatment of Carbapenem-resistant Gram-negative Bacterial Infections: a Real-world Multicenter Study

2021 ◽  
Author(s):  
Xiaojuan Zhang ◽  
Shaoyan Qi ◽  
Xiaoguang Duan ◽  
Bing Han ◽  
Shuguang Zhang ◽  
...  
Keyword(s):  
Real World ◽  
Bacterial Infections ◽  
White Blood Cells ◽  
Polymyxin B ◽  
High Morbidity ◽  
Gram Negative ◽  
Reactive Protein ◽  
Carbapenem Resistant ◽  
The Mean ◽  
Univariate Analyses

Abstract Background: High 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.Methods: The 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 variables and 28-day mortality or all-cause hospital mortality were explored through univariate analyses and multivariable logistic regression. Results: The 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%).Conclusions: Our 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.

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

scholarly journals Polymyxin B Hemoperfusion in Pneumonic Septic Shock Caused by Gram-Negative Bacteria

2015 ◽  
Vol 30 (3) ◽  
pp. 171-175
Author(s):  
Jung-Wan Yoo ◽  
Su Yeon Park ◽  
Jin Jeon ◽  
Jin Won Huh ◽  
Chae-Man Lim ◽  
...  
Keyword(s):  
Septic Shock ◽  
Polymyxin B ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Polymyxin B Hemoperfusion

Treatment of Pyonephritis Complicated by Septic Shock Using Extracorporeal Device Polymyxin B-Hemoperfusion

2020 ◽  
Vol 49 (5) ◽  
pp. 627-630
Author(s):  
Gabriele Amoruso ◽  
Nicola Di Venosa ◽  
Luigi Rizzi ◽  
Gianna Lupo ◽  
Armando Gisotti ◽  
...  
Keyword(s):  
Septic Shock ◽  
Treatment Method ◽  
Polymyxin B ◽  
Surviving Sepsis Campaign ◽  
Direct Hemoperfusion ◽  
Gram Negative ◽  
Polymyxin B Hemoperfusion ◽  
Established Treatment

Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) is an established treatment method for septic shock caused by Gram-negative infections. We report one instance in which PMX-DHP therapy has been used successfully in a 33-year-old woman with septic shock from urosepsis. Although there is lack of recommendations in latest Surviving Sepsis Campaign Guidelines, evidence of PMX-DHP efficacy in this subset of patients is growing.

scholarly journals Clinical Experience with High-Dose Polymyxin B against Carbapenem-Resistant Gram-Negative Bacterial Infections—A Cohort Study

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 451
Author(s):  
Yiying Cai ◽  
Hui Leck ◽  
Ray W. Tan ◽  
Jocelyn Q. Teo ◽  
Tze-Peng Lim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Bacterial Infections ◽  
Kidney Injury ◽  
Polymyxin B ◽  
Population Pharmacokinetic ◽  
High Dose ◽  
Pharmacokinetic Studies ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Median Daily Dose

Population pharmacokinetic studies have suggested that high polymyxin B (PMB) doses (≥30,000 IU/kg/day) can improve bacterial kill in carbapenem-resistant Gram-negative bacteria (CR-GNB). We aim to describe the efficacy and nephrotoxicity of patients with CR-GNB infections prescribed high-dose PMB. A single-centre cohort study was conducted from 2013 to 2016 on septic patients with CR-GNB infection and prescribed high-dose PMB (~30,000 IU/kg/day) for ≥72 h. Study outcomes included 30-day mortality and acute kidney injury (AKI) development. Factors associated with AKI were identified using multivariable regression. Forty-three patients with 58 CR-GNB received high-dose PMB; 57/58 (98.3%) CR-GNB were susceptible to PMB. The median daily dose and duration of high-dose PMB were 32,051 IU/kg/day (IQR, 29,340–34,884 IU/kg/day) and 14 days (IQR, 7–28 days), respectively. Thirty-day mortality was observed in 7 (16.3%) patients. AKI was observed in 25 (58.1%) patients with a median onset of 8 days (IQR, 6–13 days). Higher daily PMB dose (aOR,1.01; 95% CI, 1.00–1.02) and higher number of concurrent nephrotoxins (aOR, 2.14; 95% CI; 1.03–4.45) were independently associated with AKI. We observed that a sizable proportion developed AKI in CR-GNB patients described high-dose PMB; hence, the potential benefits must be weighed against increased AKI risk. Concurrent nephrotoxins should be avoided to reduce nephrotoxicity.

Azithromycin and Septic Shock Outcomes

2021 ◽  
pp. 089719002110641
Author(s):  
Joseph M. Johnson ◽  
Raymond J. Yost ◽  
Mark H. Pangrazzi ◽  
Katri A. Golden ◽  
Ayman O. Soubani ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Antimicrobial Treatment ◽  
Teaching Hospitals ◽  
Shock Duration ◽  
Shock Onset ◽  
Clinical Effects ◽  
Ventilation Duration ◽  
Mechanical Ventilation Duration

Introduction: Although there is evidence describing the immunomodulatory effects of macrolide antibiotics, there is little literature exploring the clinical effects these properties may have and their impact on measurable outcomes. Objective: The purpose of this study was to determine if empiric antimicrobial regimens containing azithromycin shorten time to shock resolution. Methods: A retrospective study was performed in adults with septic shock admitted to intensive care units (ICUs) of 3 university-affiliated, urban teaching hospitals between June 2012 and June 2016. Eligible patients with septic shock required treatment with norepinephrine as the first-line vasopressor for a minimum of 4 hours and received at least 48 hours of antimicrobial treatment from the time of shock onset. Propensity scores were utilized to match patients who received azithromycin to those who did not. Results: A total of 3116 patients met initial inclusion criteria. After propensity score matching, 258 patients were included, with 124 and 134 patients in the azithromycin and control groups, respectively. Median shock duration was similar in patients treated with or without azithromycin (45.6 hr vs 59.7 hr, P = .44). In-hospital mortality was also similar (37.9% vs 38.1%, P = .979). There were no significant differences in mechanical ventilation duration, ICU length of stay (LOS), or hospital LOS. Conclusions: In patients admitted to the ICU with septic shock, empiric azithromycin did not have a significant effect on shock duration, mechanical ventilation duration, ICU LOS, hospital LOS, or in-hospital mortality.

scholarly journals Risk Factors for Treatment Failure of Polymyxin B Monotherapy for Carbapenem-Resistant Klebsiella pneumoniae Infections

2013 ◽  
Vol 57 (11) ◽  
pp. 5394-5397 ◽  
Author(s):  
Yanina Dubrovskaya ◽  
Ting-Yi Chen ◽  
Marco R. Scipione ◽  
Diana Esaian ◽  
Michael S. Phillips ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Renal Insufficiency ◽  
Treatment Failure ◽  
Clinical Cure ◽  
Polymyxin B ◽  
Antimicrobial Treatment ◽  
Carbapenem Resistant

ABSTRACTPolymyxins are reserved for salvage therapy of infections caused by carbapenem-resistantKlebsiella pneumoniae(CRKP). Though synergy has been demonstrated for the combination of polymyxins with carbapenems or tigecycline,in vitrosynergy tests are nonstandardized, and the clinical effect of synergy remains unclear. This study describes outcomes for patients with CRKP infections who were treated with polymyxin B monotherapy. We retrospectively reviewed the medical records of patients with CRKP infections who received polymyxin B monotherapy from 2007 to 2011. Clinical, microbiology, and antimicrobial treatment data were collected. Risk factors for treatment failure were identified by logistic regression. Forty patients were included in the analysis. Twenty-nine of 40 (73%) patients achieved clinical cure as defined by clinician-documented improvement in signs and symptoms of infections, and 17/32 (53%) patients with follow-up culture data achieved microbiological cure. End-of-treatment mortality was 10%, and 30-day mortality was 28%. In a multivariate analysis, baseline renal insufficiency was associated with a 6.0-fold increase in clinical failure after adjusting for septic shock (odds ratio [OR] = 6.0; 95% confidence interval [CI] = 1.22 to 29.59). Breakthrough infections with organisms intrinsically resistant to polymyxins occurred in 3 patients during the treatment. Eighteen of 40 (45%) patients developed a new CRKP infection a median of 23 days after initial polymyxin B treatment, and 3 of these 18 infections were polymyxin resistant. The clinical cure rate achieved in this retrospective study was 73% of patients with CRKP infections treated with polymyxin B monotherapy. Baseline renal insufficiency was a risk factor for treatment failure after adjusting for septic shock. Breakthrough infections with organisms intrinsically resistant to polymyxin B and development of resistance to polymyxin B in subsequent CRKP isolates are of concern.

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