Infectious Diseases and Clinical Microbiology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
J Infect Chemother. 2013 Feb;19(1):57-62. doi: 10.1007/s10156-012-0451-2. Epub 2012 Jul 18.
Polymyxins have recently again become important because of multidrug-resistant (MDR) gram-negative pathogens. The aim of this study was to evaluate the clinical and microbiological efficacy and toxicity of different dosages of colistin in patients infected with MDR microorganisms that were sensitive only to colistin. The study was conducted in the 1,200-bed Ankara Numune Training and Research Hospital. Patients with normal renal function who received colistin for 48 h or more were retrospectively evaluated. Clinical response was defined as resolution of fever and clinical and laboratory findings. Microbiological response was defined as bacteriological eradication from the infection site. Nephrotoxicity was defined as at least two consecutive serum creatinine measurements with an increase of 0.5 mg/dl from baseline at least 24 h apart after 2 or more days of colistin therapy. Twenty-four patients were included in the study: total clinical response was obtained in 17 of 24 (70.8 %) patients and microbiological response in 15 of 24 (62.5 %) patients. Patients were grouped according to colistin dosage of 3 × 1 million units (MU) versus 3 × 2 MU. Clinical response rates were 69.2 % and 72.7 %, respectively (p = 0.65). Microbiological response rate was similar (p = 0.62). Nephrotoxicity was revealed in 1 of 13 patients (7.7 %) for the 3 × 1 MU group and 2 of 11 patients (18.2 %) in the 3 × 2 MU group (p = 0.57). The nephrotoxicity rate was greater with higher dosages of colistin, but the difference was not statistically significant. Renal function of patients receiving higher dosages of colistin should be more closely monitored.
多黏菌素由于耐多药（MDR）革兰氏阴性病原体的出现而再次变得重要。本研究旨在评估不同剂量黏菌素治疗仅对黏菌素敏感的 MDR 微生物感染患者的临床和微生物疗效及毒性。该研究在拥有 1200 张床位的安卡拉 Numune 培训和研究医院进行。对接受黏菌素治疗 48 小时以上且肾功能正常的患者进行回顾性评估。临床反应定义为发热消退以及临床和实验室检查结果正常。微生物学反应定义为感染部位的细菌学清除。肾毒性定义为在黏菌素治疗 2 天或更长时间后，至少连续两次血清肌酐测量值较基线升高 0.5mg/dl，且两次升高至少相隔 24 小时。本研究纳入 24 例患者：24 例患者中，17 例（70.8%）获得完全临床反应，15 例（62.5%）获得完全微生物学反应。根据黏菌素 3×100 万单位（MU）与 3×2MU 的剂量将患者分组。临床反应率分别为 69.2%和 72.7%（p=0.65）。微生物学反应率相似（p=0.62）。3×1MU 组 13 例患者中出现 1 例（7.7%）肾毒性，3×2MU 组 11 例患者中出现 2 例（18.2%）（p=0.57）。黏菌素剂量较高的患者肾毒性发生率更高，但差异无统计学意义。接受高剂量黏菌素的患者的肾功能应更密切监测。
