Katip Wasan, Uitrakul Suriyon, Oberdorfer Peninnah
Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.
Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK.
Infect Drug Resist. 2017 Sep 7;10:293-298. doi: 10.2147/IDR.S144314. eCollection 2017.
Colistin is a last-line defense therapy against extensively drug-resistant (XDR-AB). Despite a loading dose of colistin being applied in many clinical practices, studies evaluating the effect of the loading dose of colistin in cancer patients remain limited.
A retrospective cohort study of cancer patients who received either a loading or non-loading dose of colistin for treatment of XDR-AB was conducted. For each group, the clinical response, bacteriological eradication and serum creatinine were recorded. Logistic regression was applied to evaluate the effects of therapy on each of the three aforementioned outcomes.
One hundred and two patients diagnosed with XDR-AB infections between January 2012 and December 2015 were recruited. Only 75 patients were given a loading dose of colistin. There was no significant clinical and microbiological response in patients in the loading dose group or patients in the non-loading dose group. However, 38 (50.67%) patients in the loading dose group and 6 (22.22%) patients in the non-loading dose group developed nephrotoxicity according to the RIFLE criteria ( = 0.013). Multivariate logistic regression analysis showed that independent predictors of clinical response were Charlson score ≥4 and duration of colistin treatment ≥10 days. Septic shock correlated with both poor clinical and microbiological response. Independent predictors for nephrotoxicity were loading dose colistin and patient's age ≥60 years.
Administration of colistin loading dose did not significantly increase clinical response, microbiological response or mortality rate compared to non-loading dose in cancer patients with XDR-AB-related infections. However, nephrotoxicity was significantly higher when patients received loading dose colistin.
黏菌素是针对广泛耐药鲍曼不动杆菌（XDR - AB）的最后一道防线治疗药物。尽管在许多临床实践中都应用了黏菌素负荷剂量，但评估黏菌素负荷剂量对癌症患者疗效的研究仍然有限。
对接受黏菌素负荷剂量或非负荷剂量治疗XDR - AB的癌症患者进行了一项回顾性队列研究。记录每组患者的临床反应、细菌清除情况和血清肌酐水平。应用逻辑回归分析评估治疗对上述三个结果的影响。
招募了2012年1月至2015年12月期间诊断为XDR - AB感染的102例患者。只有75例患者接受了黏菌素负荷剂量。负荷剂量组患者和非负荷剂量组患者在临床和微生物学反应方面均无显著差异。然而，根据RIFLE标准，负荷剂量组有38例（50.67%）患者发生肾毒性，非负荷剂量组有6例（22.22%）患者发生肾毒性（P = 0.013）。多因素逻辑回归分析显示，临床反应的独立预测因素为Charlson评分≥4分和黏菌素治疗持续时间≥10天。感染性休克与临床和微生物学反应不佳均相关。肾毒性的独立预测因素为黏菌素负荷剂量和患者年龄≥60岁。
与非负荷剂量相比，在患有XDR - AB相关感染的癌症患者中，给予黏菌素负荷剂量并未显著提高临床反应、微生物学反应或死亡率。然而，当患者接受黏菌素负荷剂量时，肾毒性显著更高。
