Nephrotoxicity and Efficacy Assessment of Polymyxin Use in 92 Transplant Patients
Nephrotoxicity and Efficacy Assessment of Polymyxin Use in 92 Transplant Patients
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DOI：
10.1128/aac.01329-12
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发表时间：
2013-03-01
影响因子：
4.9
通讯作者：
Camargo, Luis Fernando A.
中科院分区：
文献类型：
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作者：
Mostardeiro, Marcelo M.;Pereira, Carlos A. P.;Camargo, Luis Fernando A.
多粘菌素是一种古老的抗菌药物，由于肾毒性和神经毒性报道而停产多年，最近由于多重耐药革兰氏阴性细菌感染频率的增加而重新引入。与移植患者（本研究的主要对象）的毒性和疗效相关的数据非常少。回顾性评估2001年1月至2007年12月期间使用多粘菌素的所有实体器官移植患者的肾毒性和治疗效果。微生物学和临床治愈率分别为100%和77.2%。只有接受至少 72 小时静脉注射多粘菌素治疗的移植患者才被纳入该研究。总体纳入92名移植患者，肾毒性率为32.6%。多变量分析显示多粘菌素治疗持续时间（P = 0.037；比值比 [OR]，1.06；95% 置信区间 [CI]，1.00 至 1.12）与显着肾功能障碍之间存在统计学显着相关性。多粘菌素的使用与肾功能显着下降的发生率非常高有关；因此，只有在没有其他选择的情况下才必须使用多粘菌素，并且在实体器官移植环境中使用时间尽可能短。
Polymyxins are old antimicrobials, discontinued for many years because of nephrotoxicity and neurotoxicity reports and reintroduced recently due to the increasing frequency of multiresistant Gram-negative bacterial infections. There are very few data related to toxicity and efficacy from transplanted patients, the major subjects of this study. All solid-organ-transplanted patients from our institution during January 2001 to December 2007 who used polymyxins were retrospectively assessed for nephrotoxicity and treatment efficacy. Microbiological and clinical cure rates were 100% and 77.2%, respectively. Only transplant patients subjected to at least 72 h of intravenous polymyxin were entered in the study. Overall, 92 transplant patients were included, and the nephrotoxicity rate was 32.6%. Multivariate analysis showed a statistically significant association between duration of polymyxin treatment (P = 0.037; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00 to 1.12) and significant renal dysfunction. Polymyxin use is associated with very high rates of significant decrease in renal function; therefore, polymyxin must be used only when no other option is available and for as briefly as possible in the solid organ transplant setting.