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01-04-2013 | Clinical and Epidemiological Study

Comparison of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia and tracheobronchitis caused by Pseudomonas aeruginosa or Acinetobacter baumannii

Authors: M. H. Rigatto, V. B. Ribeiro, D. Konzen, A. P. Zavascki

Published in: Infection | Issue 2/2013

Abstract

Purpose

This study was designed to compare the efficacy of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT) by Pseudomonas aeruginosa or Acinetobacter baumannii.

Methods

A prospective cohort study was performed. Patients >18 years of age with the diagnosis of VAP or VAT who received appropriate therapy for >48 h were analyzed. The primary outcome was 30-day mortality. Clinical covariates were assessed and compared between the groups.

Results

A total of 67 episodes were analyzed: 45 (67 %) treated with polymyxin B and 22 (33 %) with comparators. The crude 30-day mortality was 53 % (24 of 45) in the polymyxin B group and 27 % (6 of 22) in the comparator group (P = 0.08). Multivariable analysis using Cox regression models indicated that polymyxin B treatment was independently associated with increased mortality.

Conclusions

Polymyxin B treatment in the currently recommended dosage may be inferior to other drugs in the treatment of VAP and VAT caused by organisms tested as susceptible in vitro to this agent.

Craven DE, Hjalmarson KI. Ventilator-associated tracheobronchitis and pneumonia: thinking outside the box. Clin Infect Dis. 2010;51(Suppl 1):S59–66.PubMedCrossRef

American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.CrossRef

Zavascki AP, Carvalhaes CG, Picão RC, Gales AC. Multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii: resistance mechanisms and implications for therapy. Expert Rev Anti Infect Ther. 2010;8:71–93.PubMedCrossRef

Gales AC, Jones RN, Sader HS. Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY antimicrobial surveillance program (2006–09). J Antimicrob Chemother. 2011;66:2070–4.PubMedCrossRef

Zavascki AP, Li J. Intravenous colistimethate for multidrug-resistant Gram-negative bacteria. Lancet Infect Dis. 2008;8:403–5.PubMedCrossRef

Zavascki AP, Goldani LZ, Li J, Nation RL. Polymyxin B for the treatment of multidrug-resistant pathogens: a critical review. J Antimicrob Chemother. 2007;60:1206–15.PubMedCrossRef

Kvitko CH, Rigatto MH, Moro AL, Zavascki AP. Polymyxin B versus other antimicrobials for the treatment of Pseudomonas aeruginosa bacteraemia. J Antimicrob Chemother. 2011;66:175–9.PubMedCrossRef

Oliveira MS, Prado GV, Costa SF, Grinbaum RS, Levin AS. Ampicillin/sulbactam compared with polymyxins for the treatment of infections caused by carbapenem-resistant Acinetobacter spp. J Antimicrob Chemother. 2008;61:1369–75.PubMedCrossRef

Paul M, Bishara J, Levcovich A, Chowers M, Goldberg E, Singer P, et al. Effectiveness and safety of colistin: prospective comparative cohort study. J Antimicrob Chemother. 2010;65:1019–27.PubMedCrossRef

10.

Zavascki AP, Goldani LZ, Cao G, Superti SV, Lutz L, Barth AL, et al. Pharmacokinetics of intravenous polymyxin B in critically ill patients. Clin Infect Dis. 2008;47:1298–304.PubMedCrossRef

11.

Clinical Laboratory Standards Institute (CLSI) (2009) Performance standards for antimicrobial susceptibility testing; 19th informational supplement (M100-S19). Wayne, PA.

12.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.PubMedCrossRef

13.

Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.PubMedCrossRef

14.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.PubMedCrossRef

15.

Zarkotou O, Pournaras S, Tselioti P, Dragoumanos V, Pitiriga V, Ranellou K, et al. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment. Clin Microbiol Infect. 2011;17:1798–803.PubMedCrossRef

16.

Qureshi ZA, Paterson DL, Potoski BA, Kilayko MC, Sandovsky G, Sordillo E, et al. Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrob Agents Chemother. 2012;56:2108–13.PubMedCrossRef

17.

Elias LS, Konzen D, Krebs JM, Zavascki AP. The impact of polymyxin B dosage on in-hospital mortality of patients treated with this antibiotic. J Antimicrob Chemother. 2010;65:2231–7.PubMedCrossRef

18.

El Solh AA, Akinnusi ME, Wiener-Kronish JP, Lynch SV, Pineda LA, Szarpa K. Persistent infection with Pseudomonas aeruginosa in ventilator-associated pneumonia. Am J Respir Crit Care Med. 2008;178:513–9.PubMedCrossRef

19.

Kiem S, Schentag JJ. Impact of organism species on microbial eradication and development of resistance in severe gram-negative pneumonia. J Chemother. 2010;22:103–9.PubMed

20.

Zavascki AP, Li J, Nation RL, Superti SV, Barth AL, Lutz L, et al. Stable polymyxin B susceptibility to Pseudomonas aeruginosa and Acinetobacter spp. despite persistent recovery of these organisms from respiratory secretions of patients with ventilator-associated pneumonia treated with this drug. J Clin Microbiol. 2009;47:3064–5.PubMedCrossRef

Title: Comparison of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia and tracheobronchitis caused by Pseudomonas aeruginosa or Acinetobacter baumannii
Authors: M. H. Rigatto
V. B. Ribeiro
D. Konzen
A. P. Zavascki
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Infection / Issue 2/2013
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-012-0349-z

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Abstract

Purpose

Methods

Results

Conclusions

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