Predictors of polymyxin B treatment failure in Gram-negative healthcare-associated infections among critically ill patients

Ismail, Bahiah; Shafei, Mohd Nazri; Harun, Azian; Ali, Saedah; Omar, Mahamarowi; Deris, Zakuan Zainy

doi:10.1016/j.jmii.2017.03.007

Cited by 54 publications

(40 citation statements)

References 19 publications

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“…baumannii infections, or for HAP patients who are at high risk of acquiring MDR organisms [11,14,33,80]. Compared to polymyxin E, a significantly higher proportion of CMS is converted into colistin in vivo for polymyxin B [81]. Nevertheless, polymyxin B is not recommended as a treatment choice against GNB-related HAP/VAP presently by any expert worldwide.…”

Section: Special Considerations About Specific Antibiotics For Hap/vapmentioning

confidence: 99%

Epidemiology, Treatment, and Prevention of Nosocomial Bacterial Pneumonia

Jean

Chang

Wei

et al. 2020

JCM

101

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Septicaemia likely results in high case-fatality rates in the present multidrug-resistant (MDR) era. Amongst them are hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), two frequent fatal septicaemic entities amongst hospitalised patients. We reviewed the PubMed database to identify the common organisms implicated in HAP/VAP, to explore the respective risk factors, and to find the appropriate antibiotic choice. Apart from methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, extended-spectrum β-lactamase-producing Enterobacteriaceae spp., MDR or extensively drug-resistant (XDR)-Acinetobacter baumannii complex spp., followed by Stenotrophomonas maltophilia, Chryseobacterium indologenes, and Elizabethkingia meningoseptica are ranked as the top Gram-negative bacteria (GNB) implicated in HAP/VAP. Carbapenem-resistant Enterobacteriaceae notably emerged as an important concern in HAP/VAP. The above-mentioned pathogens have respective risk factors involved in their acquisition. In the present XDR era, tigecycline, colistin, and ceftazidime-avibactam are antibiotics effective against the Klebsiella pneumoniae carbapenemase and oxacillinase producers amongst the Enterobacteriaceae isolates implicated in HAP/VAP. Antibiotic combination regimens are recommended in the treatment of MDR/XDR-P. aeruginosa or A. baumannii complex isolates. Some special patient populations need prolonged courses (>7-day) and/or a combination regimen of antibiotic therapy. Implementation of an antibiotic stewardship policy and the measures recommended by the United States (US) Institute for Healthcare were shown to decrease the incidence rates of HAP/VAP substantially.

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Section: Special Considerations About Specific Antibiotics For Hap/vapmentioning

confidence: 99%

Epidemiology, Treatment, and Prevention of Nosocomial Bacterial Pneumonia

Jean

Chang

Wei

et al. 2020

JCM

101

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“…Multidrug-resistant organisms (MDROs) are becoming a growing public health crisis and make many healthcare-associated infections difficult to treat with current antibiotics (Boucher et al, 2009; Peleg and Hooper, 2010). Globally, infections caused by MDROs are emerging causes of morbidity and mortality (Ismail et al, 2018; Kuo et al, 2018; Ting et al, 2018; Tsao et al, 2018). The development of new antibiotics requires tremendous economic and labor investment and is time-consuming (Huh and Kwon, 2011).…”

Section: Introductionmentioning

confidence: 99%

Nanoparticles in the Treatment of Infections Caused by Multidrug-Resistant Organisms

2019

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Nanotechnology using nanoscale materials is increasingly being utilized for clinical applications, especially as a new paradigm for infectious diseases. Infections caused by multidrug-resistant organisms (MDROs) are emerging as causes of morbidity and mortality worldwide. Antibiotic options for infections caused by MDROs are often limited. These clinical challenges highlight the critical demand for alternative and effective antimicrobial strategies. Nanoparticles (NPs) can penetrate the cell membrane of pathogenic microorganisms and interfere with important molecular pathways, formulating unique antimicrobial mechanisms. In combination with optimal antibiotics, NPs have demonstrated synergy and may aid in limiting the global crisis of emerging bacterial resistance. In this review, we summarized current research on the broad classification of the NPs that have shown in vitro antimicrobial activity against MDROs, including the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species). The pharmacokinetics and pharmacodynamic characteristics of NPs and bacteria-resistant mechanisms to NPs were also discussed.

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“…[ [16][17][18] Elias et al showed (in a retrospective study) that increasing the daily dose of PMB (≥ 200 mg/ day) reduced in-hospital mortality, and that its bene ts outweighed the risk of renal insu ciency. [16] Mortality after PMB treatment was associated with an inappropriate daily dose (< 15,000 units/kg/day) in critically ill patients according to a retrospective study conducted by Ismail et al [17] An investigation on the association between the colistin dose taking into account body weight and microbiologic outcomes showed that higher doses led to better outcomes. [18] However, the exact relationship between the daily dose and e cacy of PMB was not discovered in our study.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effects of Polymyxin B in Patients infected with Carbapenem-resistant organisms

et al. 2020

Preprint

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Purpose: Carbapenem-resistant organisms (CROs) pose great challenges for clinical treatment. Polymyxin B (PMB) is one of the “last resort” choices of CRO infections. We explored the possible factors affecting PMB efficacy. Methods: This retrospective study involved CRO infected patients treated with PMB for ≥72 h. The endpoint indicator was clinical efficacy. We compared the characteristics (demographics, pathogenic bacteria, PMB treatment) between patients who had “clinical success” (CS) and “clinical failure” (CF).Results: A total of 192 patients were enrolled: 110 in the CS group and 82 in the CF group. The total cumulative dose for the CS group was higher than the CF group [1100 (700–1443.75) vs. 800 (500–1112.5) mg; P = 0.001]. Treatment duration in the CS group was longer than the CF group [11 (8–14) vs. 8 (6–11) days; P < 0.000]. Multivariate logistic regression analysis showed mechanical ventilation, vasoactive agents, multiple-site infection, and total cumulative dose to be independently associated with clinical efficacy. Cox survival analysis for 30-day mortality also showed that the use of vasoactive agents and the total cumulative dose of PMB could influence survival time and mortality rate independently.Conclusion: PMB had good efficacy and a low prevalence of adverse reactions. The total cumulative dose，duration of PMB treatment, mechanical ventilation, vasoactive agents, and multiple-site infection were factors associated with the clinical efficacy of PMB.

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Predictors of polymyxin B treatment failure in Gram-negative healthcare-associated infections among critically ill patients

Cited by 54 publications

References 19 publications

Epidemiology, Treatment, and Prevention of Nosocomial Bacterial Pneumonia

Epidemiology, Treatment, and Prevention of Nosocomial Bacterial Pneumonia

Nanoparticles in the Treatment of Infections Caused by Multidrug-Resistant Organisms

Clinical Effects of Polymyxin B in Patients infected with Carbapenem-resistant organisms

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