Polymyxin B and colistimethate are comparable as to efficacy and renal toxicity

Oliveira, Maura Salaroli de; Prado, Gladys Villas Boas do; Costa, Sílvia Figueiredo; Grinbaum, Renato Satovschi; Levin, Anna S.

doi:10.1016/j.diagmicrobio.2009.07.018

Cited by 89 publications

(67 citation statements)

References 8 publications

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“…A previous study comparing colistin and polymyxin B showed similar rates of nephrotoxicity (26% and 27%, respectively) (20). In fact, the association between baseline renal insufficiency and treatment failure in our study raises the possibility of suboptimal doses of polymyxin B given to patients with baseline renal insufficiency.…”

Section: Discussionsupporting

confidence: 70%

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

Dubrovskaya

Chen

Scipione

et al. 2013

Antimicrob Agents Chemother

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I nfections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) have been associated with poor outcomes. An overall mortality rate of 48% is reported for patients with CRKP, compared to 26% for those with carbapenem-susceptible K. pneumoniae infections (1). CRKP isolates confer resistance through the production of K. pneumoniae carbapenemases (KPCs), which are able to hydrolyze all currently available ␤-lactams, including carbapenems (2). Due to additional mechanisms of resistance commonly found in KPC-producing isolates, they often demonstrate resistance to other antimicrobial classes, including fluoroquinolones and aminoglycosides (2, 3). This limits therapeutic choices, as polymyxins (polymyxin B or colistin) and tigecycline may be the only antibiotics that retain in vitro and in vivo microbiological activity.CRKP infections are often treated with combination therapy (4, 5); however, the choice of agents is both limited and challenging. Combination therapy with aminoglycosides, if susceptibility is preserved, carries an increased risk of nephrotoxicity. Due to a high volume of distribution, low blood levels, and high MIC, tigecycline is a "last resort" option, particularly for bloodstream infections. High MICs of carbapenems preclude achieving therapeutic levels even with pharmacodynamically optimized dosing strategies. Although in vitro synergy against CRKP has been observed when polymyxin B is used in combination with rifampin, cefepime, aminoglycosides, carbapenems, or tigecycline, testing methods are nonstandardized, and therefore the clinical effect of synergy remains unclear (3,(6)(7)(8). Limited data have demonstrated survival benefits of combination therapy using polymyxin B or colistin with carbapenems and/or tigecycline for patients with CRKP bacteremia (4, 5). Given the frequently encountered challenges of combination therapy, we aimed to describe the outcomes for patients with CRKP infections treated with polymyxin B monotherapy and to identify risk factors for treatment failure. MATERIALS AND METHODSStudy design. This was a retrospective study in a tertiary care academic medical center in New York City. The study population included adult patients (aged Ն18 years) with CRKP infections who received polymyxin B monotherapy for Ն72 h. Only the first treatment course was included.Microbiology. Cases were identified from a microbiology lab report of CRKP isolates from 1 January 2007 to 15 August 2011 and by review of medical records. The Vitek-2 system (bioMérieux) used by our microbiology laboratory has built-in analysis software (version R05.01) that enables it to identify resistance phenotypes. Isolates were included if the ertapenem/imipenem MIC was reported as resistant by Vitek-2. For tigecycline and polymyxin B, susceptibility was defined as an MIC of Յ2 mg/liter by Etest, according to Food and Drug Administration (FDA) breakpoints for Enterobacteriaceae and Clinical and Laboratory Standards Institute (CLSI) breakpoints for Acinetobacter baumannii, respectively. Data collection. Patient...

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Section: Discussionsupporting

confidence: 70%

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

Dubrovskaya

Chen

Scipione

et al. 2013

Antimicrob Agents Chemother

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“…Literature reports involving polymyxin B found nephrotoxicity rates around 10.0 to 14.0% (11,12). Of note, a small study comparing the safety and efficacy of colistin versus polymyxin B found no significant differences in the rates of nephrotoxicity (13). Possible explanations for the discrepancy in the reported rates of nephrotoxicity between colistin and polymyxin B include varying definitions of nephrotoxicity, differences in the dosing regimens used, and a lack of control for risk factors such as underlying renal insufficiency.…”

mentioning

confidence: 64%

In Vitro Assessment and Multicenter Cohort Study of Comparative Nephrotoxicity Rates Associated with Colistimethate versus Polymyxin B Therapy

Phe

Lee

McDaneld

et al. 2014

Antimicrob Agents Chemother

166

154

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Despite concerns of nephrotoxicity, polymyxin antibiotics often remain the only susceptible agents for multidrug-resistant (MDR) Gram-negative bacteria. Colistin has been more commonly used clinically due to a perceived safety benefit. We compared the nephrotoxicity of colistin to polymyxin B. The in vitro cytotoxicity of colistin was compared to polymyxin B in two mammalian renal cell lines. To validate the clinical relevance of the findings, we evaluated adult patients with normal renal function who received a minimum of 72 h of polymyxin therapy in a multicenter study. The primary outcome was the prevalence of nephrotoxicity, as defined by the RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria. Colistin exhibited an in vitro cytotoxicity profile similar to polymyxin B. A total of 225 patients (121 receiving colistimethate, 104 receiving polymyxin B) were evaluated. Independent risk factors for colistimethate-associated nephrotoxicity included age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.00 to 1.07; P ‫؍‬ 0.03), duration of therapy (OR 1.08; 95% CI, 1.02 to 1.15; P ‫؍‬ 0.02), and daily dose by ideal body weight (OR 1.40; 95% CI, 1.05 to 1.88; P ‫؍‬ 0.02). In contrast, cystic fibrosis was found to be a protective factor in patients who received colistimethate (OR, 0.03; 95% CI, 0.001 to 0.79; P ‫؍‬ 0.04). In a matched analysis based on the risk factors identified (n ‫؍‬ 76), the prevalence of nephrotoxicity was higher with colistimethate than with polymyxin B (55.3% versus 21.1%; P ‫؍‬ 0.004). Polymyxin B was not found to be more nephrotoxic than colistin and may be the preferred polymyxin for MDR infections. A prospective study comparing the two polymyxins directly is warranted.

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“…Confirmando los hallazgos previamente descritos por Oliveira, y cols. 17 , quienes reportaron que la nefrotoxicidad por polimixina B estaba asociada independientemente con el aumento de la mortalidad, nuestro estudio demostró un exceso de mortalidad en pacientes que desarrollaron falla renal aguda por polimixina B.…”

Section: Discussionunclassified

Factores asociados a nefrotoxicidad por polimixina B en un hospital universitario de Neiva, Colombia. 2011-2015

Osorio

Barreto

Samboni

et al. 2017

Rev. chil. infectol.

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Polymyxin B and colistimethate are comparable as to efficacy and renal toxicity

Cited by 89 publications

References 8 publications

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

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

In Vitro Assessment and Multicenter Cohort Study of Comparative Nephrotoxicity Rates Associated with Colistimethate versus Polymyxin B Therapy

Factores asociados a nefrotoxicidad por polimixina B en un hospital universitario de Neiva, Colombia. 2011-2015

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