Alfa Institute of Biomedical Sciences, Athens, Greece; Department of Medicine, Henry Dunant Hospital Center, Athens, Greece; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA.
Alfa Institute of Biomedical Sciences, Athens, Greece; School of Applied Mathematical and Physical Sciences, National Technical University, Athens, Greece.
J Glob Antimicrob Resist. 2021 Mar;24:342-359. doi: 10.1016/j.jgar.2020.12.026. Epub 2021 Jan 21.
The epidemic dimensions of the emergence of multidrug-resistant (MDR) Gram-negative bacterial infections have led to the revival of old antibiotics, including the polymyxins.
We performed a review and meta-analysis to evaluate the current literature data regarding the effectiveness and safety of intravenous polymyxin B in patients with MDR Gram-negative bacterial infections and the overall mortality and nephrotoxicity in patients treated with intravenous polymyxin B either as monotherapy or combination therapy.
A total of 5 prospective and 28 retrospective studies, 1 cross-sectional study, 2 retrospective case series and 7 case reports provided data regarding the effectiveness and/or toxicity of intravenous polymyxin B. All-cause mortality of 2910 patients (from 27 studies) who received intravenous polymyxin B was 41.2% (95% CI 35.5-47.0%). All-cause nephrotoxicity of 2994 patients (from 28 studies) treated with intravenous polymyxin B was 40.7% (95% CI 35.0-46.6%). Renal failure among 2111 patients (from 14 studies) was 11.2% (95% CI 8.7-13.9%).
Mortality of patients treated with intravenous polymyxin B is similar to the literature-reported mortality of patients treated with intravenous colistin, while nephrotoxicity associated with polymyxin B use is possibly milder compared with colistin use based on literature data. Head-to-head prospective studies would help to clarify the benefit of polymyxin B over colistin. However, a critical evaluation of the existing worldwide literature data supports the need for availability of the intravenous formulation of polymyxin B as a potentially useful option for the treatment of patients with MDR and extensively drug-resistant (XDR) Gram-negative bacterial infections.
多药耐药（MDR）革兰氏阴性菌感染的流行规模促使包括多粘菌素在内的旧抗生素重新得到应用。
我们进行了一项综述和荟萃分析，以评估有关多粘菌素 B 静脉注射治疗 MDR 革兰氏阴性菌感染患者的疗效和安全性，以及多粘菌素 B 静脉注射单药或联合治疗患者的总体死亡率和肾毒性的现有文献数据。
共有 5 项前瞻性研究和 28 项回顾性研究、1 项横断面研究、2 项回顾性病例系列研究和 7 项病例报告提供了关于多粘菌素 B 静脉注射的疗效和/或毒性的数据。接受多粘菌素 B 静脉注射的 2910 例患者（来自 27 项研究）的全因死亡率为 41.2%（95%CI 35.5-47.0%）。接受多粘菌素 B 静脉注射治疗的 2994 例患者（来自 28 项研究）的全因肾毒性为 40.7%（95%CI 35.0-46.6%）。14 项研究中的 2111 例患者（来自 14 项研究）发生肾衰竭，发生率为 11.2%（95%CI 8.7-13.9%）。
接受多粘菌素 B 静脉注射治疗的患者的死亡率与文献报道的接受多粘菌素 B 静脉注射治疗的患者的死亡率相似，而根据文献数据，与多粘菌素 B 相关的肾毒性可能比多粘菌素 B 更轻。头对头的前瞻性研究将有助于阐明多粘菌素 B 相对于多粘菌素 B 的益处。然而，对现有全球文献数据的批判性评估支持多粘菌素 B 静脉制剂的可用性，作为治疗 MDR 和广泛耐药（XDR）革兰氏阴性菌感染患者的一种潜在有用选择。
