Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 15 123 Marousi, Athens, Greece.
Int J Antimicrob Agents. 2010 Feb;35(2):194-9. doi: 10.1016/j.ijantimicag.2009.10.005. Epub 2009 Dec 16.
It is unclear whether the effectiveness of polymyxins depends on the site of infection, the responsible pathogen, dosage, and monotherapy vs. combination therapy. We investigated colistin therapy in a large, retrospective, single-centre, cohort study. Primary analysis outcomes were infection outcome, survival and nephrotoxicity. Over a 7-year period (October 2000 to October 2007), 258 patients received intravenous (i.v.) colistin for at least 72h for microbiologically documented multidrug-resistant Gram-negative bacterial infections, comprising 170 (65.9%) Acinetobacter baumannii, 68 (26.4%) Pseudomonas aeruginosa, 18 (7.0%) Klebsiella pneumoniae, 1 (0.4%) Stenotrophomonas maltophilia and 1 (0.4%) Enterobacter cloacae. Cure of infection occurred in 79.1% of patients, nephrotoxicity in 10% and hospital survival in 65.1%. In the multivariate analysis, independent predictors of survival were colistin average daily dose [adjusted odds ratio (aOR)=1.22, 95% confidence interval (CI) 1.05-1.42] and cure of infection (aOR=9, 95% CI 3.6-23.1), whilst the proportion of creatinine change (aOR=0.21, 95% CI 0.1-0.45), Acute Physiology and Chronic Health Evaluation (APACHE) II score (aOR=0.89, 95% CI 0.84-0.95) and haematological disease (aOR=0.23, 95% CI 0.08-0.66) were associated with mortality. Effectiveness of colistin was not dependent on the type of pathogen. No independent predictors for nephrotoxicity were observed. The findings of the largest cohort study to date on i.v. colistin show that colistin is a valuable antibiotic with acceptable nephrotoxicity and considerable effectiveness that depends on the daily dosage and infection site.
目前尚不清楚多黏菌素的疗效是否取决于感染部位、病原体、剂量、单药治疗与联合治疗。我们在一项大型回顾性单中心队列研究中对黏菌素治疗进行了调查。主要分析结局为感染结局、生存和肾毒性。在 7 年期间（2000 年 10 月至 2007 年 10 月），258 例患者因微生物学确诊的多重耐药革兰氏阴性菌感染接受至少 72 小时的静脉（i.v.）黏菌素治疗，其中 170 例（65.9%）为鲍曼不动杆菌、68 例（26.4%）为铜绿假单胞菌、18 例（7.0%）为肺炎克雷伯菌、1 例（0.4%）为嗜麦芽窄食单胞菌和 1 例（0.4%）为阴沟肠杆菌。79.1%的患者感染治愈，10%发生肾毒性，65.1%的患者住院存活。多变量分析显示，存活的独立预测因素为黏菌素平均日剂量[校正比值比（aOR）=1.22，95%置信区间（CI）1.05-1.42]和感染治愈（aOR=9，95%CI 3.6-23.1），而肌酐变化比例（aOR=0.21，95%CI 0.1-0.45）、急性生理学和慢性健康评估（APACHE）II 评分（aOR=0.89，95%CI 0.84-0.95）和血液系统疾病（aOR=0.23，95%CI 0.08-0.66）与死亡率相关。黏菌素的疗效不取决于病原体的类型。未观察到肾毒性的独立预测因素。迄今为止最大的静脉黏菌素队列研究的结果表明，黏菌素是一种有价值的抗生素，具有可接受的肾毒性和相当大的疗效，这取决于日剂量和感染部位。
