Aerosolized Plus Intravenous Polymyxin B Versus Colistin in the Treatment of Pandrug-Resistant Klebsiella Pneumonia-mediated Ventilator-Associated Pneumonia: A Retrospective Cohort Study in Bangladesh
, , , et | 08 mai 2023
À propos de cet article
Article Category: Research Article
Publié en ligne: 08 mai 2023
Pages: 106 - 115
Reçu: 10 oct. 2022
Accepté: 12 avr. 2023
DOI: https://doi.org/10.2478/jccm-2023-0012
Mots clés
© 2023 Md Jahidul Hasan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.
Fig. 1.
Clinical outcomes in patients treated with intravenous and aerosolized polymyxin B or colistin
| Parameters | PMB group (N=106) | CLN group (N=116) | P value |
|---|---|---|---|
| Microbial eradication, n (%) | 88 (83) | 79 (68.1) | 0.001 |
| 21-day secondary bacterial infection, n (%) | 24 (22.64) | 28 (27.58) | 0.013 |
| Length-of-intubation (day), median (IQR) | 10 (9-12.25) | 14 (11-19) | 0.001 |
| Length-of-ICU stay (day), median (IQR) | 12 (10-14) | 15 (9-18.5) | 0.072 |
| Adverse drug event, n (%) | |||
| Bronchospasm | 39 (36.79) | 8 (6.89) | 0.001 |
| Nephrotoxicity | 12 (11.32) | 33 (28.44) | 0.002 |
Susceptibility of Klebsiella pneumoniae to all available antibiotics according to the CLSIa and EUCASTb guideline.
| Antibiotics | Clinical breakpoints (μg/mL) | MIC (μg/mL) | Interpretation | Comment: Type of resistance |
|---|---|---|---|---|
| Amikacin | ≤ 16, 32, ≥ 64 | > 16 | Resistant | Pandrug-resistant |
| Cefepime | ≤ 2, 4-8, ≥ 16 | > 16 | Resistant | |
| Cefixime | ≤ 1, 2, ≥ 4 | > 2 | Resistant | |
| Ceftazidime/Avibactam | ≤ 8/4, ≥ 16/4 | > 8/4 | Resistant | |
| Ceftriaxone | ≤ 1, 2, ≥ 4 | > 4 | Resistant | |
| Cefuroxime | ≤ 4, 8-16, ≥ 32 | > 8 | Resistant | |
| Ciprofloxacin | ≤ 1, 2, ≥ 4 | > 1 | Resistant | |
| Colistin | ≤ 2, ≥ 4 | > 2 | Resistant | |
| Gentamicin | ≤ 4, 8, ≥ 16 | > 4 | Resistant | |
| Imipenem | ≤ 1, 2, ≥ 4 | > 4 | Resistant | |
| Levofloxacin | ≤ 2, 4, ≥ 8 | > 2 | Resistant | |
| Meropenem | ≤ 1, 2, ≥ 4 | > 8 | Resistant | |
| Piperacillin/Tazobactam | ≤ 16/4, ≥ 28/4 | > 64/4 | Resistant | |
| Polymyxin B | ≤ 2, ≥ 4 | > 2 | Resistant | |
| Tigecycline | ≤ 1, 2, ≥ 2 | > 2 | Resistant |
Results from the Cox Proportional Hazard model. GROUP=main variable (polymyxin B versus colistin).
| Variable | HR | 95% CI | P value | |
|---|---|---|---|---|
| Lower | Upper | |||
| Group | 0.035 | 0.007 | 0.168 | <0.001 |
| Age | 1.028 | 1.001 | 1.055 | 0.045 |
| PaO2/FiO2 ratio | 1.005 | 0.994 | 1.015 | 0.379 |
| APACHE II | 0.958 | 0.862 | 1.063 | 0.415 |
| Microbial non-eradication | 1.148 | 0.484 | 2.721 | 0.038 |
| Length of intubation | 0.965 | 0.882 | 1.057 | 0.044 |
| Length of ICU stay | 1.043 | 0.99 | 1.099 | 0.117 |
Baseline demographic information, comorbidity and laboratory findings in patients.
| Variable | PMB group (N=106) | CLN group (N=116) | P value |
|---|---|---|---|
| Male/female, n (%) | 78/28 (74/26) | 62/54 (53/47) | |
| Age (year), median (IQR) | 56 (44.5-68) | 55 (46-65) | 0.091 |
| Fever (°F), median (IQR) | 100.5 (100-101) | 101 (100-101) | 0.559 |
| Diabetes, n (%) | 89 (83.95) | 97 (83.62) | 0.022 |
| Hypertension, n (%) | 72 (67.93) | 80 (68.96) | 0.421 |
| CVD, n (%) | 61 (57.52) | 53 (45.68) | 0.542 |
| Bronchial asthma, n (%) | 27 (25.51) | 30 (25.86) | 0.031 |
| CKD, n (%) | 25 (23.63) | 31 (26.72) | 0.011 |
| COPD, n (%) | 25 (23.6) | 27 (23.27) | 0.058 |
| Obesity, n (%) | 22 (20.82) | 18 (15.51) | 0.316 |
| PUD, n (%) | 19 (17.94) | 8 (6.89) | 0.644 |
| CLD, n (%) | 9 (8.55) | 12 (10.34) | 0.021 |
| PD, n (%) | 4 (3.86) | 9 (7.75) | 0.465 |
| SpO2 (%), median (IQR) | 96 (93-98) | 96 (94-98) | 0.249 |
| FiO2, median (IQR) | 50 (40-65) | 45 (40-65) | 0.939 |
| Respiratory rate, (breaths/min), median (IQR) | 19 (16-24) | 21 (18.29-24.7) | 0.487 |
| Heart rate (beat/min), median (IQR) | 87 (83-97.37) | 85 (78-90) | 0.487 |
| PaO2/FiO2 (mmHg) , median (IQR) | 240 (193-255) | 243 (206.72-256) | 0.517 |
| CRP (mg/L), median (IQR) | 158 (136-268.3) | 152.5 (125-243.81) | 0.282 |
| Procalcitonin (ng/mL), median (IQR) | 5 (3.35-8) | 6 (4.81-9) | 0.114 |
| WBC (K/μL), median (IQR) | 18 (16.52-21) | 16.46 (13.2-24) | 0.001 |
| Neutrophils (%), median (IQR) | 65 (55.77-75) | 75 (65-85) | 0.454 |
| Platelet (K/μL), median (IQR) | 186 (151-263) | 162 (125-242.5) | 0.132 |
| D-dimer (mg /L FEU), median (IQR) | 0.96 (0.36-1.74) | 0.57 (0.35-1.4) | 0.005 |
| LDH ((U/L), median (IQR) | 419 (314-522) | 425 (356.5-500.25) | 0.117 |
| Serum creatinine (mg/dL), median (IQR) | 0.9 (0.7-1.2) | 1 (0.8-1.6) | 0.097 |
| ALT (U/L), median (IQR) | 56 (45-76) | 57 (45-75) | 0.597 |
| AST (U/L), median (IQR) | 48 (39-58) | 46 (34-59) | 0.813 |
| Bilirubin (mg/dL), median (IQR) | 0.8 (0.47-0.9) | 0.8 (0.6-0.92) | 0.737 |
| MEWS, median (IQR) | 4 (3-4) | 4 (3-4) | 0.032 |
| APACHE II (score range: 0-71) , median (IQR) | 20 (20-24) | 20 (18-24) | 0.171 |