Colistin effectiveness and nephrotoxicity: experience from a tertiary care burns unit in Oman

Al-Busaidi, Said; Mohammed, Adil; Murugan, Vinod Kalarikal; Thankappan, Sabu

doi:10.1007/s00238-013-0827-2

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…MDR and MRSA colonization and infection is a global issue and has a negative impact on the survival of burn patients. As with any other country, Oman has these organisms present and they are typically difficult to eradicate [16].…”

Section: Discussionmentioning

confidence: 99%

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Alsafy,

Jacob,

Elias

et al. 2024

MPS

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Background: Early excision and grafting has been the preferred method of managing major burns around the world since 1970. Considering the advances in health care and the development of new antibiotics over the past 50 years, delayed grafting as a technique for the management of burns over 15% -20% of total body surface area (TBSA) could have comparable results to that of early excision. This study aims to highlight the outcomes of practicing delayed grafting in burn patients. Methods: A case series analysis was performed of 51 patients who were admitted to the burns unit in Sultan Qaboos Hospital Salalah with over 20% TBSA between January 2014 and December 2019. The patients received prophylactic antibiotics and silver sulphadiazine dressing until the burn eschar had completely separated, followed by grafting. Results: Two patients were lost during the entire duration of the study. The mortality rate was comparable to that of early excision, while the rate of hypertrophic scarring was lower than the range reported by other studies. Conclusion: In the management of patients with over 20% TBSA, delayed grafting after complete separation of eschar is still a valid technique.

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Section: Discussionmentioning

confidence: 99%

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Alsafy,

Jacob,

Elias

et al. 2024

MPS

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“…3 In recent years, a rise in multidrugresistant organisms occurred, especially Acinetobacter baumannii. 4 This organism was previously not a common cause of infection in burn patients. A 2002 report from Sweden showed that MRSA and coagulase-negative Staphylococcus were the most common infecting organisms in the studied unit, while A. baumannii was one of the least common infecting organisms.…”

Section: Discussionmentioning

confidence: 99%

“…The reported range in some studies is 27-68%. [1][2][3][4][5][6][7][8] In recent years, a rise in multidrug-resistant microorganisms occurred, making the control of blood stream infection more difficult due to the limited availability of appropriate antibiotics. 3 This study reviews the blood stream infections of major burn patients in a tertiary care burn unit in Oman, with the aim of identifying the most prevalent infecting microorganisms.…”

mentioning

confidence: 99%

Analysis of Blood Cultures from Major Burns Patients in a Tertiary Care Burn Unit in Oman

Albusaidi,

Al Jabri,

Al Hadhrami

et al. 2024

Sultan Qaboos Univ Med J

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Objectives: In this study we review blood stream infections of major burns in a tertiary care burn unit to determine the most prevalent organisms in order to have a better empirical therapy protocol. Methods: This is a retrospective study where blood stream infection of major burns (>20% Total Body Surface Area) were analysed. Results:155 patients fulfilled the criteria. Median age was 33 years. Median TBSA was 38%. 57.42% were males and 42.58% were females. Mortality was 25.16%. 50.9% of patients had positive blood culture. Expired patients had higher TBSA, Abbreviated Burns Severity Index score and earlier first positive blood culture. The most prevalent organisms grown from all blood cultures were Acinetobacter, staphylococci, Klebsiella, Enterococcus and pseudomonas. Candida is also commonly grown in blood cultures. All Acinetobacter species are always multidrug resistant. 8 of 14 patients had multidrug resistant Klebsiella. There were only 4 patients who had Methicilin resistant Staphylococcus Aureus (MRSA) grown. The number of blood cultures samples taken ranged from 1 to 28 (median 6). First positive blood culture showed that Staphylococcus epidermidis and Acinetobacter are the most common organisms. Conclusion: In conclusion multidrug resistant Acinetobcater has become the most predominant microorganism grown in blood cultures of major burns in our unit. Empirical therapy should include antibiotics that are effective against it to reduce the mortality. Keywords: Infection; Blood; Burn; Resistance; Antibiotics; Culture.

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“…studies reported recovery rates after AKI during polymyxin treatment; these varied widely, ranging from 12% to 100%. Eleven of 46 studies reported recovery in more than 90% patients [38,57,96,136,152,200,204,223,225,228,244], 17 of 46 studies reported recovery rates of 50e90% [7,8,34,48,63,67,68,71,74,84,115,117,183,187,220,222,240] and 18 of 46 studies reported recovery in 50% patients [13,58,67,79,91,104,112,130,148,151,156,162e164, 198,201,208,245]. However, it should be noted that studies differed in the criteria used to define recovery (return to baseline, return to within normal range, no longer meeting criteria for AKI or undefined), the time period of follow-up (end of treatment to 1 year, where given) and the way in which missing data were handled.…”

Section: Nephrotoxicitymentioning

confidence: 99%

Re: ‘Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis’ by Tleyjeh et al.

Koeckerling

Pan

Barker

2021

Clinical Microbiology and Infection

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Background: Nephrotoxicity and neurotoxicity are commonly associated with polymyxin treatment; however, the emergence of multidrug-resistant Gram-negative bacteria with limited therapeutic options has resulted in increased use of polymyxins. Objectives: To determine the rates of nephrotoxicity and neurotoxicity during polymyxin treatment and whether any factors influence these. Data sources: Medline, Embase and Cochrane Library databases were searched on 2 January 2020. Study eligibility criteria: Studies reporting nephrotoxicity and/or neurotoxicity rates in patients with infections treated with polymyxins were included. Reviews, meta-analyses and reports not in English were excluded. Participants: Patients hospitalized with infections treated with systemic or inhaled polymyxins were included. For comparative analyses, patients treated with nonepolymyxin-based regimens were also included. Methods: Meta-analyses were performed using a random-effects model; subgroup meta-analyses were conducted where data permitted using a mixed-effects model. Results: In total, 237 reports of randomized controlled trials, cohort and caseecontrol studies were eligible for inclusion; most were single-arm observational studies. Nephrotoxic events in 35,569 patients receiving polymyxins were analysed. Overall nephrotoxicity rate was 0.282 (95% confidence interval (CI) 0.259e0.307). When excluding studies where >50% of patients received inhaled-only polymyxin treatment or nephrotoxicity assessment was by methods other than internationally recognized criteria (RIFLE, KDIGO or AKIN), the nephrotoxicity rate was 0.391 (95% CI 0.364e0.419). The odds of nephrotoxicity were greater with polymyxin therapies compared to nonepolymyxin-based regimens (odds ratio 2.23 (95% CI 1.58e3.15); p < 0.001). Meta-analyses showed a significant effect of polymyxin type, dose, patient age, number of concomitant nephrotoxins and use of diuretics, glycopeptides or vasopressors on the rate of nephrotoxicity. Polymyxin therapies were not associated with a significantly different rate of neurotoxicity than nonepolymyxin-based regimens (p 0.051). The overall rate of neurotoxicity during polymyxin therapy was 0.030 (95% CI 0.020e0.043).

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Colistin effectiveness and nephrotoxicity: experience from a tertiary care burns unit in Oman

Cited by 7 publications

References 13 publications

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Delayed Grafting as a Valid Technique in Burn Management: Experience from a Burn Unit in Oman

Analysis of Blood Cultures from Major Burns Patients in a Tertiary Care Burn Unit in Oman

Re: ‘Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis’ by Tleyjeh et al.

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