Efficacy and safety of colistin sulfate in the treatment of infections caused by carbapenem-resistant organisms: a multicenter retrospective cohort study

Journal of Thoracic Disease

article

Danyang Peng¹  Fan Zhang²  Yinyin Chen¹  Congyi Zhao¹  Jingjing Niu²  Jianxu Yang²  Zhifeng Li²  Chao Chen²  Shi Qiu²  Huifeng Zhang²  Bingyu Qin²  Xiang Fang³  Suping Guo⁴  Ying Liu⁵  Huanzhang Shao² 

[1] Department of Critical Care Medicine, Henan University People’s Hospital;Department of Critical Care Medicine, Henan Provincial People’s Hospital;Department of Pulmonary and Critical Care Medicine, Chest Hospital of Henan Province;Department of Cardiac Intensive Care Unit, Fuwai Central China Cardiovascular Hospital, Henan Provincial People’s Hospital;Department of Critical Medicine, The Second Affiliated Hospital of Zhengzhou University

关键词: Carbapenem-resistant organisms (CRO);    colistin sulfate;    clinical improvement;    adverse reactions;    28-day all-cause mortality;   

DOI  :  10.21037/jtd-23-336

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Polymyxins have become an important treatment option for carbapenem-resistant organisms (CRO) infections. However, there is a rare of clinical studies on colistin sulfate. This study sought to investigate the rate of clinical improvement and adverse reactions of colistin sulfate in the treatment of severe infections caused by CRO in critically ill patients and assess the factors associated with 28-day all-cause mortality. Methods: This multicenter retrospective cohort study included intensive care unit (ICU) patients who received colistin sulfate due to CRO infections during July 2021 and May 2022. The primary endpoint was clinical improvement at end of therapy. Secondary endpoints included adverse reactions bacterial clearance rate and 28-day all-cause mortality. Results: A total of 122 patients, who were included between July 2021 and May 2022, were included in this study, of whom 86 (70.5%) showed clinical improvement and 36 (29.5%) showed clinical failure. The comparison of the clinical data of the patients showed that the median sequential organ failure assessment (SOFA) score was higher in the failure group than the improvement group {9.5 [7, 11] vs. 7 [4, 9], P=0.002}, the proportion of patients receiving extracorporeal membrane oxygenation (ECMO) was higher in the failure group than the improvement group (27.8% vs. 12.8%, P=0.046), and the median duration of treatment was longer in the improvement group than the failure group {12 [8, 15] vs. 5.5 [4, 9.75], P<0.001}. A total of 5 (4.1%) patients suffered from acute kidney injury due to increases in creatinine during colistin sulfate treatment. The Cox regression survival analysis showed that the SOFA score [hazards ratio (HR) =1.198, P=0.001], ECMO treatment (HR =2.373, P=0.029), and duration of treatment (HR =0.736, P<0.001) were independently associated with 28-day all-cause mortality. Conclusions: Colistin sulfate is a reasonable choice for the treatment of CRO infections in the current treatment options are limited. The possible kidney injury caused by the colistin sulfate requires intensive monitoring.

【 授权许可】

Unknown