Colistin versus polymyxin B: A pragmatic assessment of renal and neurological adverse effects and effectiveness in multidrug-resistant Gram-negative bacterial infections.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2023-07-01 DOI:10.4103/ijp.ijp_762_20

Veneta Simon, Aathira Viswam, Pallavi Sarah Alexander, Emmanuel James, S Sudhindran

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Abstract

Objectives: Our study aimed to evaluate the real-world data on renal and neurological adverse effects and effectiveness of colistimethate sodium (CMS) and polymyxin B (PMB).

Materials and methods: An observational prospective study was performed on inpatients receiving CMS and PMB for multidrug-resistant Gram-negative bacterial infections. CMS dose was titrated to renal function, and serum creatinine was assessed daily. The incidence of nephrotoxicity, the primary outcome, was evaluated based on an increase in serum creatinine from baseline as well as by the Risk, Injury, Failure, Loss of kidney function, and End-stage renal disease criteria. Neurological adverse effects were assessed based on clinical signs and symptoms, and the causality and severity were assessed by the Naranjo scale and modified Hartwig-Siegel scale, respectively. The effectiveness of polymyxin therapy was ascertained by a composite of microbiological eradication of causative bacteria and achievement of clinical cure. Thirty-day all-cause mortality was also determined.

Results: Between CMS and PMB, the incidence of nephrotoxicity (59.3% vs. 55.6%, P = 0.653) or neurotoxicity (8.3% vs. 5.6%, P = 0.525) did not significantly differ. However, reversal of nephrotoxicity was significantly more with patients receiving CMS than PMB (48.4% vs. 23.3%, P = 0.021). Favorable clinical outcomes (67.6% vs. 37%, P < 0.001) and microbiological eradication of causative bacteria (73.1% vs. 46.3%, P = 0.001) were significantly more with CMS than PMB. Patients treated with CMS had lower all-cause mortality than those with PMB treatment (19.4% vs. 42.6%, P = 0.002).

Conclusion: There is no significant difference in the incidence of renal and neurotoxic adverse effects between CMS and PMB when CMS is administered following renal dose modification. CMS shows better effectiveness and lower mortality compared to PMB.

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粘菌素与多粘菌素B：对耐多药革兰氏阴性细菌感染的肾脏和神经系统不良反应和有效性的实用评估。

目的：我们的研究旨在评估科利司汀钠（CMS）和多粘菌素B（PMB）的肾脏和神经系统不良反应和有效性的真实数据。材料和方法：对因耐多药革兰氏阴性菌感染而接受CMS和PMB治疗的住院患者进行前瞻性观察研究。CMS剂量被滴定到肾功能，并且每天评估血清肌酸酐。肾毒性的发生率是主要结果，根据血清肌酸酐比基线的增加以及风险、损伤、衰竭、肾功能丧失和终末期肾病标准进行评估。神经系统不良反应根据临床体征和症状进行评估，因果关系和严重程度分别通过Naranjo量表和改良的Hartwig-Siegel量表进行评估。多粘菌素治疗的有效性是通过微生物根除致病菌和实现临床治愈来确定的。还确定了30天的全因死亡率。结果：CMS和PMB的肾毒性发生率（59.3%vs.55.6%，P=0.653）或神经毒性发生率（8.3%vs.5.6%，P=0.525）没有显著差异。然而，CMS患者的肾毒性逆转率明显高于PMB（48.4%对23.3%，P=0.021）。CMS患者的良好临床结果（67.6%对37%，P<0.001）和病原菌的微生物根除率（73.1%对46.3%，P=0.001）明显高于PMB。CMS患者的全因死亡率低于PMB患者（19.4%对42.6%，P=0.002）。与PMB相比，CMS显示出更好的有效性和更低的死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.