Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
J Antimicrob Chemother. 2010 May;65(5):1019-27. doi: 10.1093/jac/dkq069. Epub 2010 Mar 18.
Colistin has re-entered clinical use by necessity. We aimed to assess its effectiveness and safety compared with newer antibiotics.
This was a single-centre, prospective cohort study. Inclusion criteria were microbiologically documented pneumonia, urinary tract infection, surgical site infection, meningitis or bacteraemia treated appropriately with colistin versus imipenem, meropenem or ampicillin/sulbactam (comparators). All consecutive patients were included, only once, between May 2006 and July 2009. The primary outcome was 30 day mortality. Multivariable and Cox regression survival analyses were used to adjust comparisons between groups. Odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals are reported.
Two hundred patients treated with colistin and 295 patients treated with comparators were included. Treatment with colistin was associated with older age, admission from healthcare facilities, mechanical ventilation and lower rate of early appropriate antibiotic treatment. The 30 day mortality was 39% (78/200) for colistin versus 28.8% (85/295) for comparators; unadjusted OR 1.58 (1.08-2.31). In the adjusted analysis the OR was 1.44 (0.91-2.26) overall and 1.99 (1.06-3.77) for bacteraemic patients (n = 220). At the end of follow-up, treatment with colistin was significantly associated with cumulative mortality; adjusted HR 1.27 (1.01-1.60) overall and 1.65 (1.18-2.31) among patients with bacteraemia. Nephrotoxicity at the end of treatment was more frequent with colistin; OR adjusted for other risk factors for nephrotoxicity 3.31 (1.54-7.08). Treatment with colistin was followed by increased incidence of Proteus spp. infections during a 3 month follow-up.
The need for colistin treatment is associated with poorer survival. Adjusted analyses suggest that colistin is less effective and more toxic than beta-lactam antibiotics.
多粘菌素已重新投入临床应用。我们旨在评估其与新型抗生素相比的疗效和安全性。
这是一项单中心前瞻性队列研究。纳入标准为微生物学证实的肺炎、尿路感染、手术部位感染、脑膜炎或菌血症，用多粘菌素治疗，而不是用亚胺培南、美罗培南或氨苄西林/舒巴坦（对照）治疗。2006 年 5 月至 2009 年 7 月期间，连续入组所有符合条件的患者，仅入组一次。主要结局为 30 天死亡率。多变量和 Cox 回归生存分析用于调整组间比较。报告比值比（OR）或风险比（HR）及其 95%置信区间。
共纳入 200 例多粘菌素治疗患者和 295 例对照治疗患者。多粘菌素治疗组年龄较大，入院来自医疗机构，需要机械通气，早期适当抗生素治疗的比例较低。30 天死亡率多粘菌素组为 39%（78/200），对照组为 28.8%（85/295）；未调整的 OR 为 1.58（1.08-2.31）。在调整分析中，总体 OR 为 1.44（0.91-2.26），菌血症患者为 1.99（1.06-3.77）。在随访结束时，多粘菌素治疗与累积死亡率显著相关；调整后的 HR 为 1.27（1.01-1.60），菌血症患者为 1.65（1.18-2.31）。治疗结束时，多粘菌素的肾毒性更常见；调整其他肾毒性危险因素后的 OR 为 3.31（1.54-7.08）。多粘菌素治疗后，3 个月随访期间 Proteus spp.感染的发生率增加。
多粘菌素治疗的需要与生存率降低相关。调整分析表明，多粘菌素的疗效不如β-内酰胺类抗生素，毒性更大。
