Durakovic Nadira, Radojcic Vedran, Boban Ana, Mrsic Mirando, Sertic Dubravka, Serventi-Seiwerth Ranka, Nemet Damir, Labar Boris
Department of Internal Medicine, Division of Hematology, Clinical Hospital Center Zagreb, Croatia.
Intern Med. 2011;50(9):1009-13. doi: 10.2169/internalmedicine.50.4270. Epub 2011 May 1.
A rise in infections with multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is a significant contributor to increased morbidity and mortality of patients with hematologic malignancies. The aim of this study was to determine the efficacy and safety of colistin (colistimethate sodium) in the treatment of serious infections caused by MDR-PA in these patients.
A matched pair analysis of renal function, toxicities, and outcome of 26 patients receiving colistin and control subjects was done. All patients had clinical signs of sepsis; P. aeruginosa was isolated from blood in 69% of patients in colistin group and 84% in control group. Patients treated with colistin received 3 million units every 8 hours for a median duration of 13 days. Additionally, patients received at least two additional antimicrobial or antifungal drugs.
Resolution of infection was achieved in twenty patients (76.9%) receiving colistin and in 17 (65.4%) control subjects. Mortality rate was 11% in both groups. There was no statistically significant difference in the level of serum creatinine, creatinine clearance, or potassium levels before and after treatment between groups. Only one patient receiving colistin developed de novo renal failure and one displayed transient neurologic toxicity.
Our results suggest that in patients with hematologic malignancies, colistin is effective in treating severe infections caused by MDR-PA while maintaining an acceptable toxicity profile. Prospective randomized studies comparing efficacy and safety of colistin with those of other antipseudomonal drugs are needed.
多重耐药铜绿假单胞菌（MDR-PA）感染率上升是导致血液系统恶性肿瘤患者发病率和死亡率增加的重要因素。本研究旨在确定多粘菌素（多粘菌素甲磺酸钠）治疗这些患者由MDR-PA引起的严重感染的疗效和安全性。
对26例接受多粘菌素治疗的患者和对照者进行肾功能、毒性及预后的配对分析。所有患者均有败血症的临床体征；多粘菌素组69%的患者血液中分离出铜绿假单胞菌，对照组为84%。接受多粘菌素治疗的患者每8小时接受300万单位治疗，中位疗程为13天。此外，患者至少还接受了两种其他抗菌或抗真菌药物。
接受多粘菌素治疗的20例患者（76.9%）和17例对照者（65.4%）感染得到缓解。两组死亡率均为11%。两组治疗前后血清肌酐水平、肌酐清除率或血钾水平无统计学显著差异。仅1例接受多粘菌素治疗的患者出现新发肾衰竭，1例出现短暂神经毒性。
我们的结果表明，对于血液系统恶性肿瘤患者，多粘菌素在治疗由MDR-PA引起的严重感染时有效，且毒性可接受。需要进行前瞻性随机研究，比较多粘菌素与其他抗假单胞菌药物的疗效和安全性。
