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
, , , oraz
08 maj 2023
O artykule
Kategoria artykułu: Research Article
Data publikacji: 08 maj 2023
Zakres stron: 106 - 115
Otrzymano: 10 paź 2022
Przyjęty: 12 kwi 2023
DOI: https://doi.org/10.2478/jccm-2023-0012
Słowa kluczowe
© 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 |