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The Susceptibility of MDR-K. Pneumoniae to Polymyxin B Plus its Nebulised Form Versus Polymyxin B Alone in Critically Ill South Asian Patients

Md. Jahidul Hasan

Md. Jahidul Hasan

Clinical Pharmacy Services, Square Hospitals LtdDhaka, Bangladesh
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Hasan, Md. Jahidul
, 
Raihan Rabbani

Raihan Rabbani

ICU and Internal Medicine, Square Hospitals LtdDhaka, Bangladesh
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Rabbani, Raihan
, 
Ahmad Mursel Anam

Ahmad Mursel Anam

High Dependency Unit (HDU), Square Hospitals LtdDhaka, Bangladesh
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Anam, Ahmad Mursel
, 
Ario Santini

Ario Santini

University of Medicine, Pharmacy, Science and Technology of TarguMures, Romania
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Santini, Ario
 and 
Shihan Mahmud Redwanul Huq

Shihan Mahmud Redwanul Huq

ICU and Internal Medicine, Square Hospitals LtdDhaka, Bangladesh
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Huq, Shihan Mahmud Redwanul
  
Jan 29, 2021
The Susceptibility of MDR-K. Pneumoniae to Polymyxin B Plus its Nebulised Form Versus Polymyxin B Alone in Critically Ill South Asian Patients's Cover Image
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Article Category: Research Article
Published Online: Jan 29, 2021
Page range: 28 - 36
Received: Jul 15, 2020
Accepted: Nov 23, 2020
DOI: https://doi.org/10.2478/jccm-2020-0044
Keywords
© 2021 Md. Jahidul Hasan, Raihan Rabbani, Ahmad Mursel Anam, Ario Santini, Shihan Mahmud Redwanul Huq, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1

Kaplan-Meier 30-day survival curve for intravenous polymyxin B with nebulization (green line) and only intravenous polymyxin B (blue line). Analysis run using Group (polymyxin B intravenously with nebulization vs intravenous polymyxin B only) as factor; death as event and time to death as time variable.
Kaplan-Meier 30-day survival curve for intravenous polymyxin B with nebulization (green line) and only intravenous polymyxin B (blue line). Analysis run using Group (polymyxin B intravenously with nebulization vs intravenous polymyxin B only) as factor; death as event and time to death as time variable.

Fig. 2

Adverse events associated with polymyxin B in both the groups (polymyxin B intravenously with nebulization vs intravenous polymyxin B alone)
Adverse events associated with polymyxin B in both the groups (polymyxin B intravenously with nebulization vs intravenous polymyxin B alone)

Clinical outcomes of patients with intravenous polymyxin B with or without the nebulised form_

Parameter Odds ratio (95% confidence interval) p-value
Microbial eradication 0.19 (0.06-0.58) 0.003
Secondary bacterial infection 0.17 (0.05-0.59) 0.005
30-day mortality 0.45 (0.14-1.43) 0.178

Demographic and baseline characteristics of the patients

Variables
Characterisitcs
p-value
PIVNL group (n=64) PIV group (n=57)
Age (year)
Mean 64.1±16.1 63.9±14.3
Range (min-max) 20-86 20-87 0.950
Gender
Male 37 33
Female 27 24 0.993
Comorbidities
Hypertension, n (%) 31 (48.4) 26 (45.6) 0.756
Diabetes mellitus, n (%) 30 (46.8) 27 (47.3) 0.957
Chronic lung diseases, n (%) 16 (25) 13 (22.8) 0.778
APACHE II Score (0-30)
Mean 18±4.8 18.3±5.5
Range (min-max) 10–30 8–30 0.727
C-reactive protein (<10.0 mg/mL)
Mean 161.7(112.8) 139.2±105.3
Range (min-max) 11.7–393.6 10.3–390.3 0.260
Procalcitonin (<0.1 ng/mL)
Mean 7.5(17.3) 7.4±14.4
Range (min-max) 0.2–114 0.1–68.5 0.976
White blood cell (4-11 K/μL)
Mean 19.2(7.3) 18.9±7.3
Range (min-max) 9.7–46.1 11.1–47.6 0.823
Serum creatinine (0.8-1.4 mg/dL)
Mean 1.6(0.5) 1.5±0.5
Range (min-max) 0.6–2.3 0.6–2.5 0.905

Extubation, reintubation and hospitalisation time of the patients

Group Time to extubation, n (%) p-value ICU length-of-stay, n (%) p-value 21-day reintubation, n (%) P value
≥4 weeks: nil ≥4 weeks: 4 (6.25)
PIVNL ≥3 weeks: 1 (1.5) ≥3 weeks: 7 (10.9)
(n=64) ≥2 weeks: 19 (29.7) ≥2 weeks: 38 (59.4) 8 (12.5)
≥1 week: 40 (62.5) ≥1 week: 14 (21.9)
<1 week: 4 (6.3) <1 week: 1 (1.6)
≥4 weeks: 13 (22.8) 0.001** ≥1 weeks: 36 (63.2) 0.002** 0.089**
≥3 weeks: 15 (26.3) ≥3 weeks: 14 (24.5)
PIV ≥2 weeks: 25 (43.9) ≥2 weeks: 4 (7.0) 17 (29.8)
(n=57) ≥1 week: 4 (7.0) ≥1 week: nil
<1 week: nil <1 week: 3 (5.3)
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