Safety and efficacy of intravenous colistin (colistin methanesulphonate) for severe multidrug-resistant Gram-negative bacterial infections
Safety and efficacy of intravenous colistin (colistin methanesulphonate) for severe multidrug-resistant Gram-negative bacterial infections
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DOI：
10.1016/j.ijantimicag.2009.11.016
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发表时间：
2010-03-01
影响因子：
10.8
通讯作者：
Chang, Shan-Chwen
中科院分区：
文献类型：
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作者：
Cheng, Chien-Yu;Sheng, Wang-Huei;Chang, Shan-Chwen
多药耐药（MDR）细菌感染在台湾医院日益增加，促使多粘菌素的普遍使用。本研究对静脉注射粘菌素的安全性和有效性进行了评价。对台湾某医疗中心2006年1月至2008年9月间接受粘菌素治疗耐多药革兰氏阴性细菌感染患者的医疗记录进行回顾性分析。记录人口统计学、临床表现、病原生物、不良事件和结局。在分析的115例患者记录中，74例患者（64%）在重症监护病房接受治疗。常见的基础疾病是高血压（49%）、慢性肺病（46%）、慢性肾病（33%）和恶性肿瘤（31%）。最常见的是下呼吸道感染（71%），其次是原发性血流感染（12%）、尿路感染（8.7%）和其他感染（7.8%）。59例（51%）患者成功地静脉注射粘菌素治疗耐多药革兰氏阴性细菌感染。多因素分析显示，较高的急性生理和慢性健康评估（APACHE） II评分（优势比= 1.14；95%可信区间1.02-1.28;P = 0.02）与较差的临床反应独立相关。总体而言，84例患者中有12例（14%）出现肾毒性，4例（3.5%）出现神经毒性。综上所述，粘菌素对于耐多药革兰氏阴性菌引起的严重感染是一种有效的抗菌药物。临床结果与感染和基础疾病的严重程度有关。与以前的报道相比，本研究显示肾毒性和神经毒性发生率较低。(C) 2009 Elsevier B.V.与International Society of Chemotherapy。版权所有。
Multidrug-resistant (MDR) bacterial infections are increasing in Taiwan hospitals, prompting the common use of colistin. In this study, the safety and efficacy of intravenous (i.v.) colistin was assessed. The medical records of patients receiving colistin for treatment of MDR Gram-negative bacterial infections between January 2006 and September 2008 at a Taiwan medical centre were reviewed retrospectively. Demographics, clinical presentation, causative organism, adverse events and outcomes were recorded. Of the 115 patient records analysed, 74 patients (64%) were treated in the Intensive Care Unit. Common underlying diseases were hypertension (49%), chronic pulmonary disease (46%), chronic kidney disease (33%) and malignancy (31%). Lower respiratory tract infections were most common (71%), followed by primary bloodstream infections (12%), urinary tract infections (8.7%) and others (7.8%). Successful treatment with i.v. colistin against MDR Gram-negative bacterial infections occurred in 59 patients (51%). Multivariate analysis showed that a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio = 1.14; 95% confidence interval 1.02-1.28; P = 0.02) was independently associated with a poor clinical response. Overall, 12 (14%) of 84 patients presented nephrotoxicity and 4 patients (3.5%) had neurotoxicity. In conclusion, colistin is an effective antimicrobial agent for severe infections caused by MDR Gram-negative bacteria. Clinical outcomes are associated with the severity of infection and underlying diseases. Compared with previous reports, this study showed a lower incidence of nephrotoxicity and neurotoxicity. (C) 2009 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.