Department of Infectious Diseases, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.
Infection Control Department, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil.
Clin Infect Dis. 2023 Jul 5;77(Suppl 1):S62-S69. doi: 10.1093/cid/ciad272.
Our aim in this retrospective cohort study was to assess the impact on mortality of the empirical use of polymyxin as therapy for carbapenem-resistant gram-negative bacteria (CR-GNB) in septic patients. The study was performed at a tertiary academic hospital in Brazil, from January 2018 to January 2020, the pre-coronavirus disease 2019 period.
We included 203 patients with suspected sepsis. The first doses of antibiotics were prescribed from a "sepsis antibiotic kit", which contained a selection of drugs, including polymyxin, with no preapproval policy. We developed a logistic regression model to assess risk factors associated with 14-day crude mortality. Propensity score for polymyxin was used to control biases.
Seventy (34%) of 203 patients had infections with at least 1 multidrug-resistant organism isolated from any clinical culture. Polymyxins in monotherapy or in combination therapy were prescribed to 140 of the 203 (69%) patients. The overall 14-day mortality rate was 30%. The 14-day crude mortality was associated with age (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 1.01-1.05; P = .01), SOFA (sepsis-related organ failure assessment) score value (aOR, 1.2; 95% CI, 1.09-1.32; P < .001), CR-GNB infection (aOR, 3.94; 95% CI, 1.53-10.14; P = .005), and time between suspected sepsis and antibiotic administration (aOR, 0.73; 95% CI, .65-.83; P < .001). The empirical use of polymyxins was not associated with decreased crude mortality (aOR, 0.71; 95% CI, .29-1.71; P = .44).
Empirical use of polymyxin for septic patients in a setting with high CR-GNB prevalence was not associated with decreased crude mortality.
在这项回顾性队列研究中，我们旨在评估经验性使用多粘菌素治疗脓毒症患者耐碳青霉烯革兰阴性菌（CR-GNB）对死亡率的影响。该研究于 2018 年 1 月至 2020 年 1 月在巴西的一家三级学术医院进行，处于 2019 年冠状病毒病之前的时期。
我们纳入了 203 例疑似脓毒症患者。抗生素的首剂是根据“脓毒症抗生素包”开出的，其中包含了多粘菌素等几种药物，无需事先批准。我们开发了一个逻辑回归模型来评估与 14 天粗死亡率相关的危险因素。多粘菌素的倾向评分用于控制偏差。
203 例患者中有 70 例（34%）的感染至少有一种从任何临床培养物中分离出的多药耐药菌。203 例患者中有 140 例（69%）接受了多粘菌素单药或联合治疗。总的 14 天死亡率为 30%。14 天的粗死亡率与年龄（调整后的优势比[aOR]，1.03；95%置信区间[CI]，1.01-1.05；P =.01）、SOFA（脓毒症相关器官衰竭评估）评分值（aOR，1.2；95%CI，1.09-1.32；P <.001）、CR-GNB 感染（aOR，3.94；95%CI，1.53-10.14；P =.005）和疑似脓毒症与抗生素使用之间的时间（aOR，0.73；95%CI，0.65-0.83；P <.001）有关。经验性使用多粘菌素与降低粗死亡率无关（aOR，0.71；95%CI，0.29-1.71；P =.44）。
在 CR-GNB 流行率较高的环境中，对脓毒症患者经验性使用多粘菌素与降低粗死亡率无关。
