Bahiah Ismail1, Mohd Nazri Shafei2, Azian Harun3, Saedah Ali4, Mahamarowi Omar4, Zakuan Zainy Deris5. 1. Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Hospital Kuala Krai, 18000 Kuala Krai, Kelantan, Malaysia. 2. Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. 3. Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. 4. Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. 5. Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; Infection Control and Hospital Epidemiology Unit, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Electronic address: zakuan@usm.my.
Abstract
BACKGROUND: With increasing prevalence and spread of multidrug resistant Gram-negative infections, parenteral polymyxins resurged in clinical practice. The primary aim of the study was to determine the predictors of treatment failure and in-hospital mortality among critically ill patients treated with polymyxin B. METHODS: Demographic data, underlying diseases, procedures and details on polymyxin B therapy were retrospectively analyzed in a cohort of 84 patients who received intravenous polymyxin B in an intensive care unit from 2010 to 2014. RESULTS: Polymyxin B was used to treat bacteremia (46.4% of cases) and pneumonia (53.6%). Majority of the pathogens isolated were Acinetobacter spp. (96.4%). The mortality rate was 48.8%, of which 82.9% was attributed to polymyxin B treatment failure. The independent predictors of treatment failure were low doses of polymyxin B (p = 0.002), shorter duration of therapy (p = 0.009), not combining with cefoperazone/sulbactam (p = 0.030), female gender (p = 0.004), administered for treatment of bacteremia (p = 0.023) and renal impairment (p = 0.021). Low polymyxin B doses (p = 0.007), not combining with cefoperazone/sulbactam (p = 0.024), female gender (p = 0.048) and renal impairment (p = 0.022) were also significant predictors for in-hospital mortality. CONCLUSIONS: To the best of our knowledge, this is the first report on the association of inadequate dose of polymyxin B (<15,000 units/kg/day) with poor outcome in critically ill patients. Besides that, further clinical studies are warranted to evaluate the use of cefoperazone/sulbactam as second antibiotic in the combination therapy.
BACKGROUND: With increasing prevalence and spread of multidrug resistant Gram-negative infections, parenteral polymyxins resurged in clinical practice. The primary aim of the study was to determine the predictors of treatment failure and in-hospital mortality among critically illpatients treated with polymyxin B. METHODS: Demographic data, underlying diseases, procedures and details on polymyxin B therapy were retrospectively analyzed in a cohort of 84 patients who received intravenous polymyxin B in an intensive care unit from 2010 to 2014. RESULTS: Polymyxin B was used to treat bacteremia (46.4% of cases) and pneumonia (53.6%). Majority of the pathogens isolated were Acinetobacter spp. (96.4%). The mortality rate was 48.8%, of which 82.9% was attributed to polymyxin B treatment failure. The independent predictors of treatment failure were low doses of polymyxin B (p = 0.002), shorter duration of therapy (p = 0.009), not combining with cefoperazone/sulbactam (p = 0.030), female gender (p = 0.004), administered for treatment of bacteremia (p = 0.023) and renal impairment (p = 0.021). Low polymyxin B doses (p = 0.007), not combining with cefoperazone/sulbactam (p = 0.024), female gender (p = 0.048) and renal impairment (p = 0.022) were also significant predictors for in-hospital mortality. CONCLUSIONS: To the best of our knowledge, this is the first report on the association of inadequate dose of polymyxin B (<15,000 units/kg/day) with poor outcome in critically illpatients. Besides that, further clinical studies are warranted to evaluate the use of cefoperazone/sulbactam as second antibiotic in the combination therapy.
Authors: Osama A Madkhali; Sivakumar Sivagurunathan Moni; Muhammad H Sultan; Haitham A Bukhary; Mohammed Ghazwani; Nabil A Alhakamy; Abdulkarim M Meraya; Saeed Alshahrani; Saad Saeed Alqahtani; Mohammed Ali Bakkari; M Intakhab Alam; Mohamed Eltaib Elmobark Journal: Sci Rep Date: 2021-05-10 Impact factor: 4.379