Mariano Filippo, Malvasio Valeria, Risso Daniela, Depetris Nadia, Pensa Anna, Fucale Giacomo, Gennari Fabrizio, Biancone Luigi, Stella Maurizio
Nephrology, Dialysis and Transplantation U, Department of General and Specialized Medicine, City of Science and Health, CTO Hospital, Torino, Italy.
Department of Medical Sciences, University of Torino, Torino, Italy.
Int J Gen Med. 2022 May 25;15:5211-5221. doi: 10.2147/IJGM.S357427. eCollection 2022.
Colistin is still a therapeutic cornerstone against multidrug-resistant gram-negative bacteria (MDRGN), mostly when other antibiotics do not gain adequate activity on these strains. In the present study, we evaluated in a cohort of burn patients the relationship between colistin therapy, survival and requirement of renal replacement therapy (CRRT).
Retrospective study of 133 burn patients treated with iv colistimethate sodium (loading dose 9.0 × 10 IU, maintenance dose 4.5 × 10 IU BID) and 35 treated with other antibiotics for MDRGN infection including , , and between January 2008 and December 2017. Multivariate analysis with logistic regression was used to determine the effect of the predictors such as age, total body surface area (TBSA), third-degree burn areas, Revised Baux score, Charlson comorbidity score, length of stay, colistin dose and duration of treatment, mechanical ventilation, and need of CRRT on in-hospital mortality. To investigate the relationship between colistin and renal function, we focused on survivor patients as the completion of the therapeutic course of colistin represented the basic requirement to analyze its impact on the kidney.
Out of 133 colistin- and 35 other antibiotics-treated patients, 83 (62.4%) and 31 (88.6%) survived, and 53 (39.8%) and 3 (9.7%) required CRRT, respectively. The severity of burns, as well as CRRT requirement and mortality, was significantly higher in colistin-treated patients than in other antibiotics-treated patients. Age and TBSA% were the significant predictors of mortality. Out of 83 colistin-treated survivors, 19 (22.9%) required CRRT (9 before and 10 after the start of colistin), and 64 (77.1%) had a normal renal function. No difference about the colistin dose and baseline characteristics, but the revised Baux score was found between the 9 patients requiring CRRT before the colistin course and the 10 patients after. Similarly, among the 64 patients not undergoing CRRT, no difference was found between the patients treated with the cumulative dose of colistin <99.0 × 10 IU (n = 33, median daily dose of 4.0 × 10 IU) and >99.0 × 10 IU (n = 31, median daily dose of 9.0 × 10 IU) about the baseline characteristics and the daily median plasma creatinine over 24 days of therapy.
Colistin therapy was associated with more severe burns, mortality, and CRRT requirement. A short course therapy, at appropriate cumulative dosage, can lead to clinical success without a significant association with severe renal impairment.
多粘菌素仍是治疗多重耐药革兰氏阴性菌（MDRGN）的基石，尤其是在其他抗生素对这些菌株未获得足够活性时。在本研究中，我们在一组烧伤患者中评估了多粘菌素治疗、生存与肾脏替代治疗（CRRT）需求之间的关系。
回顾性研究2008年1月至2017年12月期间133例接受静脉注射多粘菌素甲磺酸钠（负荷剂量9.0×10 IU，维持剂量4.5×10 IU，每日两次）治疗的烧伤患者以及35例接受其他抗生素治疗MDRGN感染（包括 、 及 ）的患者。采用逻辑回归进行多变量分析，以确定年龄、总体表面积（TBSA）、三度烧伤面积、修订版Baux评分、Charlson合并症评分、住院时间、多粘菌素剂量和治疗持续时间、机械通气以及CRRT需求等预测因素对住院死亡率的影响。为研究多粘菌素与肾功能之间的关系，我们将重点放在存活患者上，因为完成多粘菌素治疗疗程是分析其对肾脏影响的基本要求。
在133例接受多粘菌素治疗和35例接受其他抗生素治疗的患者中，分别有83例（62.4%）和31例（88.6%）存活，53例（39.8%）和3例（9.7%）需要CRRT。多粘菌素治疗患者的烧伤严重程度、CRRT需求和死亡率显著高于其他抗生素治疗患者。年龄和TBSA%是死亡率的显著预测因素。在83例接受多粘菌素治疗的存活患者中，19例（22.9%）需要CRRT（多粘菌素开始治疗前9例，开始治疗后10例），64例（77.1%）肾功能正常。在多粘菌素疗程前需要CRRT的9例患者和疗程后10例患者之间，多粘菌素剂量和基线特征无差异，但修订版Baux评分有差异。同样，在64例未接受CRRT的患者中，接受多粘菌素累积剂量<99.0×10 IU（n = 33，每日中位剂量4.0×10 IU）和>99.0×10 IU（n = 31，每日中位剂量9.0×10 IU）治疗的患者在基线特征和24天治疗期间的每日血浆肌酐中位数方面无差异。
多粘菌素治疗与更严重的烧伤、死亡率和CRRT需求相关。短疗程治疗，采用适当的累积剂量，可取得临床成功，且与严重肾功能损害无显著关联。
