1. Predictors of polymyxin B treatment failure in Gram-negative healthcare-associated infections among critically ill patients
- Author
-
Saedah Ali, Zakuan Zainy Deris, Mahamarowi Omar, Mohd Nazri Shafei, Bahiah Ismail, and Azian Harun
- Subjects
Male ,0301 basic medicine ,Polymyxin ,lcsh:QR1-502 ,Bacteremia ,Pharmacology ,lcsh:Microbiology ,law.invention ,Tertiary Care Centers ,0302 clinical medicine ,Risk Factors ,law ,Immunology and Allergy ,Treatment Failure ,030212 general & internal medicine ,Polymyxin B ,Cross Infection ,biology ,Mortality rate ,General Medicine ,Sulbactam ,Middle Aged ,Intensive care unit ,Anti-Bacterial Agents ,Intensive Care Units ,Cefoperazone ,Infectious Diseases ,Administration, Intravenous ,Drug Therapy, Combination ,Female ,Acinetobacter Infections ,medicine.drug ,Adult ,Microbiology (medical) ,medicine.medical_specialty ,medicine.drug_class ,Critical Illness ,030106 microbiology ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Aged ,Retrospective Studies ,General Immunology and Microbiology ,business.industry ,Malaysia ,Pneumonia ,Acinetobacter ,medicine.disease ,biology.organism_classification ,Gram-Negative Bacterial Infections ,business - 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 (
- Published
- 2018