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VOLUME 12 , ISSUE 4 ( December, 2008 ) > List of Articles

ORIGINAL ARTICLE

Safety and efficacy of polymyxin B in multidrug resistant gram-negative severe sepsis and septic shock

Ayanava Majumdar, Purnendu Sekhar Das

Keywords : Acute renal failure, Gram-negative organisms, multidrug resistant, polymyxin B, severe sepsis and septic shock

Citation Information : Majumdar A, Das PS. Safety and efficacy of polymyxin B in multidrug resistant gram-negative severe sepsis and septic shock. Indian J Crit Care Med 2008; 12 (4):153-157.

DOI: 10.4103/0972-5229.45074

License: CC BY-ND 3.0

Published Online: 01-12-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and Aims: The emergence of multidrug resistant strains of Gram-negative bacteria, especially the lactose nonfermenters like Pseudomonas and Acinetobacter, in the intensive care units have prompted renewed worldwide interest in the polymyxins. However, perceived nephrotoxicity has been a major vexation limiting their early and regular use in severe sepsis. This study was conducted to assess the safety and efficacy of polymyxin B in patients with severe sepsis and septic shock. Materials and Methods: Forty-five patients with sepsis admitted in our medical-surgical intensive care units were identified from pharmacy records to have received polymyxin B. We retrospectively reviewed the clinical and microbiologic outcomes as well as occurrence of renal failure temporally related to the use of intravenous polymyxin B. Results: polymyxin B was used in severe sepsis and septic shock with the isolated organism being resistant to other available antimicrobials or clinical deterioration despite carbapenem use. Overall mortality was 52% and among patients who received at least eight days of intravenous polymyxin B, 67% patients with initial septic shock and 62% with severe sepsis survived. The target multidrug resistant organism was cleared in 88% of subjects evaluated by repeat microbiologic testing. Acute renal failure developed in only two patients (4%). Conclusions: Polymyxin B has acceptable effectiveness against nosocomial multidrug resistant Gram-negative sepsis. The associated nephrotoxicity has been found to be significantly lower than previously reported even in patients with background renal impairment and established risk factors of renal failure.


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  1. Antimicrobial resistance in intensive care units. Clin Chest Med 1999;20:303-16.
  2. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med 2001;29:N64-8.
  3. Clinical problems posed by multiresistant nonfermenting gram-negative pathogens. Clin Infect Dis 1998;27:S117-24.
  4. Economic impact of antimicrobial resistance. Emerg Infect Dis 2001;7:286-92.
  5. Antibiotic-resistant infections in the critically ill adult. Clin Lab Med 2004;24:329-41.
  6. Polymyxin B Sulfate and Colistin: Old antibiotics for emerging multiresistant gram-negative bacteria. Ann Pharmacother 1999;33:960-7.
  7. Polymyxins: Pharmacology, pharmacokinetics, pharmacodynamics and clinical applications. Infect Dis Clin N Am 2003;17:545-62.
  8. Effects of large doses of colistin sulfomethate on renal function. Br Med J 1970;4:525-7.
  9. Neurotoxic effects of colistin in patients with renal disease. N Engl J Med 1963;266:759-62.
  10. Surviving sepsis campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004;32:858-73.
  11. Intravenous colistin as therapy for nosocmial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumanii. Clin Infect Dis 1999;28:1008-11.
  12. The clinical use of colistin in patients with cystic fibrosis. Curr Opin Pulm Med 2001;7:434-40.
  13. The use of intravenous and aerosolized polymyxins for the treatment of infections in critically ill patients: A review of recent literature. Clin Med Res 2006;4:138-46.
  14. Colistin: The revival of polymyxins for the management of multiresistant gram-negative bacterial infections. Clin Infect Dis 2005;40:1333.
  15. Treatment of multidrug-resistant Acinetobacter baumanii ventilator associated pneumonia (VAP) with intravenous colistin: A comparison with imipenem susceptible VAP. Clin Infect Dis 2003;36:1111-8.
  16. Treatment of nososcomial pneumonia and tracheobronchitis caused by multidrug-resistant Pseudomonas aeruginosa with aerosolized colistin. Am J Respir Crit Care Med 2000;162:328-30.
  17. Use of parenteral colistin for the treatment of serious infection due to antimicrobial-resistant Pseudomonas aeruginosa. Clin Infect Dis 2003;37:e154-60.
  18. Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: The renaissance of an old antibiotic. Clin Microbiol Infect 2005;11:115-21.
  19. Polymyxin B nephrotoxicity and efficacy against nosocomial infections caused by multiresistant gram-negative bacteria. Antimicrob Agents Chemother 2003;47:2659-62.
  20. Combination therapy with polymyxin B for the treatment of multidrug-resistant Gram-negative respiratory tract infections. J Antimicrob Chemother 2004;54:566-9.
  21. Trends in antimicrobial drug development implications for the future. Clin Infect Dis 2004;38:1279-86.
  22. Adverse effects of sodium colistimethate-manifestations and specific reaction rates during 317 courses of therapy. Ann Intern Med 1970;72: 857-68.
  23. Toxicity of polymyxins: A systematic review of evidence from old and recent studies. Crit Care 2006;10:R27.
  24. Polymyxin B, colistin and sodium colistimethate. Med Clin N Am 1982;66:135-42.
  25. Polymyxin B and colistin. N Engl J Med 1964;270:1030-5.
  26. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368-77.
  27. Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Crit Care Med 2007;35:1105-12.
  28. Acute renal failure and sepsis. N Engl J Med 2004;351:159-69.
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