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Parenteral polymyxin B use in patients with multidrug-resistant gram-negative bacteremia and urinary tract infections: a retrospective case series.

AbstractBACKGROUND:
Parenteral polymyxin use declined after the 1960s, due to safety concerns. An increase in multidrug-resistant (MDR) gram-negative infections and a shortage of new agents have prompted increased use of parenteral polymyxin.
OBJECTIVE:
To describe our clinical experience with parenteral polymyxin B for MDR gram-negative bacteremia and urinary tract infection (UTI).
METHODS:
Paper pharmacy records were used to identify patients aged 18 years or older, presence of MDR gram-negative bacteremia or UTI, and use of parenteral polymyxin B for at least 48 hours. Electronic and paper patient records were then retrospectively reviewed. Polymyxin B susceptibility was evaluated using the Kirby-Bauer method. MDR isolates were defined as resistant to at least 3 antimicrobial classes, excluding polymyxin B. Microbiologic clearance was defined by 1 repeat urine or 2 repeat blood cultures that were sterile or growing different organisms. Secondary outcomes included hospital mortality and nephrotoxicity, defined as an increase in serum creatinine of 0.5 mg/dL or more, or a 50% reduction in creatinine clearance.
RESULTS:
Seventeen infections in 16 patients were treated with polymyxin B (1 pt. had 2 infections that were analyzed separately). Microbiologic clearance occurred in 14 of 16 (88%) cases of MDR gram-negative bacteremia or UTI in which repeat cultures were done. Ten of 16 patients died (all-cause mortality 63%). Five patients required hemodialysis prior to polymyxin B use. Six (55%) of the remaining 11 patients with baseline renal insufficiency developed nephrotoxicity, and none of them required hemodialysis. The mean +/- SD number of days from the initiation of therapy to the onset of nephrotoxicity was 7.5 +/- 2.3 (range 4-10) days. Three (50%) of 6 patients with nephrotoxicity died.
CONCLUSIONS:
Our data suggest that polymyxin B may be effective for MDR gram-negative infections in patients with limited therapeutic options, but precautions should be taken to avoid toxicity.
AuthorsAndrew A Pastewski, Patricia Caruso, Addison R Parris, Ramon Dizon, Robert Kopec, Shobha Sharma, Suri Mayer, Monica Ghitan, Edward K Chapnick
JournalThe Annals of pharmacotherapy (Ann Pharmacother) Vol. 42 Issue 9 Pg. 1177-87 (Sep 2008) ISSN: 1542-6270 [Electronic] United States
PMID18664609 (Publication Type: Journal Article)
Chemical References
  • Anti-Bacterial Agents
  • Polymyxin B
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents (administration & dosage, adverse effects, therapeutic use)
  • Bacteremia (drug therapy, microbiology)
  • Drug Resistance, Multiple, Bacterial
  • Gram-Negative Bacteria (drug effects)
  • Gram-Negative Bacterial Infections (drug therapy)
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Polymyxin B (administration & dosage, adverse effects, therapeutic use)
  • Retrospective Studies
  • Urinary Tract Infections (drug therapy, microbiology)

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