Colistin efficacy in the treatment of multidrug-resistant and extremelydrug-resistant gram-negative bacterial infections*

Abstract

IntroductionThe polymyxin group of polypeptide antibiotics is among the first antibiotics, discovered in the 1940s, with significant activity against gram-negative bacteria. Both polymyxin E (colistin) and polymyxin B were used clinically. Following reports on nephrotoxicity and neurotoxicity in the 1970s, other antibiotics were used instead of them. In the last decade, this group was reconsidered as a therapeutic option for multidrug-resistant/extremely drug-resistant gram-negative (MDR/XDR-GN) bacterial infections and particularly for the carbapenem-resistant Acinetobacter species (1,2).After its reintroduction in medical practice in the last 5 years, studies focused on the effectiveness and the side effects of colistin, especially nephrotoxicity. Nephrotoxicity after intravenous colistin treatment was observed at rates of 6%-58% in recent studies. Rates of 10%-27% and 58% were found in patients with basal normal and abnormal renal functions, respectively (3,4).The difference in the nephrotoxicity rates was explained by various definitions of acute kidney injury. Some studies used RIFLE criteria (risk, injury, failure, loss, and endstage kidney disease), while some used the threshold of failure or creatinine level of more than 2 mg/dL. Risk factors for nephrotoxicity were older age, preexisting renal insufficiency, hypoalbuminemia, hyperbilirubinemia, and concomitant use of nonsteroidal antiinflammatory drugs, calcineurin inhibitors, or other nephrotoxic agents like vancomycin (1,5,6).In this study, the efficiency against nosocomial MDR/ XDR-GN bacterial infections and risk of nephrotoxicity with intravenous colistin treatment were investigated. Materials and methods Study designThis retrospective study includes the records of patients treated with intravenous colistin between January 2011 and February 2013 in Celal Bayar University Hospital in Background/aim: Colistin is used as a salvage therapy for multidrug-resistant and extremely drug-resistant gram-negative bacterial infections. Our aim was to evaluate colistin efficiency and toxicity in the treatment of these resistant gram-negative bacterial infections. Materials and methods:This is a retrospective study carried out in a tertiary care hospital during 2011-2013. Study data were collected from the medical records and consultations of the infectious diseases clinic. Results:The study group included 158 patients with nosocomial infections and 136 (86.1%) of them were hospitalized in the ICU. Respiratory tract infections were the most commonly observed ones (n = 103, 65.2%). The most frequently isolated microorganism was Acinetobacter baumannii (72.2%). A total of 98 (62.0%) patients had clinical cure. There was no statistically significant difference between monotherapy (n = 3/6, 50.0%) and combination therapies (n = 95/152, 62.5%) according to clinical response. Underlying ultimately fatal disease, previous renal disease, and total parenteral nutrition were independent risk factors for poor clinical response. Nephrotoxicity developed in 80 (50.6%) patients...

Monotherapy versus combination therapy for multidrug-resistant Gram-negative infections: Systematic Review and Meta-Analysis

“…Addressed infections ranged from pneumonia (n = 10 studies) 7–16 , blood stream infections (n = 15 studies) 17–31 , osteoarticular infections (n = 1 study) 32 , and studies comprising mixed forms of infections (n = 27 studies) 33–59 . Two of the included studies were RCTs 36,43 , six case-control studies 7,9,15,17,53,55 and forty-five case series/cohort studies 8,10–14,16,18–35,37–42,44–52,54,56–59 . The studies included a total of 4514 patients: 41% of patients (n = 1848) were treated with monotherapy, 59% (n = 2666) with combination therapy.

Figure 1Study selection.

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Emergence of Nosocomial Pneumonia Caused by Colistin-Resistant Escherichia coli in Patients Admitted to Chest Intensive Care Unit

“…The increased resistance to multiple antibiotics in Gram-negative bacteria presents significant global health-care problems because these MDR Gram-negative pathogens are often not controlled by the available and effective antibiotics [42][43][44]. The advent of MDR Gram-negative bacteria in recent years has made colistin an effective therapeutic alternative for various infections [45]. Two types of risk factor have been described for nosocomial pneumonia: the patient and factors related to infection prevention.…”

Cryptococcal infection in HIV-infected patients with CD4+ T-cell counts under 100/μL diagnosed in a high-income country: a multicentre cohort study

“…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.…”