Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Int J Antimicrob Agents. 2010 Mar;35(3):297-300. doi: 10.1016/j.ijantimicag.2009.11.016. Epub 2009 Dec 31.
Multidrug-resistant (MDR) bacterial infections are increasing in Taiwan hospitals, prompting the common use of colistin. In this study, the safety and efficacy of intravenous (i.v.) colistin was assessed. The medical records of patients receiving colistin for treatment of MDR Gram-negative bacterial infections between January 2006 and September 2008 at a Taiwan medical centre were reviewed retrospectively. Demographics, clinical presentation, causative organism, adverse events and outcomes were recorded. Of the 115 patient records analysed, 74 patients (64%) were treated in the Intensive Care Unit. Common underlying diseases were hypertension (49%), chronic pulmonary disease (46%), chronic kidney disease (33%) and malignancy (31%). Lower respiratory tract infections were most common (71%), followed by primary bloodstream infections (12%), urinary tract infections (8.7%) and others (7.8%). Successful treatment with i.v. colistin against MDR Gram-negative bacterial infections occurred in 59 patients (51%). Multivariate analysis showed that a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (odds ratio=1.14; 95% confidence interval 1.02-1.28; P=0.02) was independently associated with a poor clinical response. Overall, 12 (14%) of 84 patients presented nephrotoxicity and 4 patients (3.5%) had neurotoxicity. In conclusion, colistin is an effective antimicrobial agent for severe infections caused by MDR Gram-negative bacteria. Clinical outcomes are associated with the severity of infection and underlying diseases. Compared with previous reports, this study showed a lower incidence of nephrotoxicity and neurotoxicity.
台湾医院的多重耐药（MDR）细菌感染正在增加，促使普遍使用黏菌素。本研究评估了静脉注射（i.v.）黏菌素的安全性和疗效。回顾性分析了 2006 年 1 月至 2008 年 9 月在台湾某医疗中心接受黏菌素治疗 MDR 革兰氏阴性菌感染的患者的病历。记录了人口统计学、临床表现、病原体、不良事件和结局。在分析的 115 份患者记录中，74 名患者（64%）在重症监护病房接受治疗。常见的基础疾病包括高血压（49%）、慢性肺部疾病（46%）、慢性肾脏疾病（33%）和恶性肿瘤（31%）。下呼吸道感染最为常见（71%），其次是原发性菌血症（12%）、尿路感染（8.7%）和其他感染（7.8%）。59 名患者（51%）经静脉注射黏菌素治疗 MDR 革兰氏阴性菌感染获得成功。多变量分析显示，较高的急性生理学和慢性健康评估（APACHE）II 评分（比值比=1.14；95%置信区间 1.02-1.28；P=0.02）与不良临床反应独立相关。总体而言，84 名患者中有 12 名（14%）出现肾毒性，4 名患者（3.5%）出现神经毒性。总之，黏菌素是治疗 MDR 革兰氏阴性菌引起的严重感染的有效抗菌药物。临床结局与感染的严重程度和基础疾病有关。与以往的报告相比，本研究显示肾毒性和神经毒性的发生率较低。
