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INFECTIOUS DISEASES

Parenteral Polymyxin B Use in Patients with Multidrug-Resistant Gram-Negative Bacteremia and Urinary Tract Infections: A Retrospective Case Series

Fellow, Division of Infectious Diseases, Department of Medicine, Maimonides Medical Center, Brooklyn, NY

Patricia Caruso, BSPharm MS

Infectious Diseases Clinical Pharmacist, Department of Pharmacy, Maimonides Medical Center

Addison R Parris, MD

Attending, Division of Infectious Diseases, Department of Medicine, Rockingham Memorial Hospital, Harrisonburg, VA

Ramon Dizon, MD

Attending, Infectious Diseases, Saint Luke's Hospital, Saint Vincent's Medical Center, Orange Park Medical Center, Jacksonville, FL

Robert Kopec, MD

Attending, Department of Medicine, Morton Plant Hospital, Clearwater, FL

Shobha Sharma, DO

Attending, Division of Infectious Diseases, Department of Medicine, Maimonides Medical Center

Suri Mayer, BSPharm

Infectious Diseases Clinical Pharmacist, Department of Pharmacy, Maimonides Medical Center

Monica Ghitan, MD

Program Director, Associate Director, Division of Infectious Diseases, Department of Medicine, Maimonides Medical Center

Edward K Chapnick, MD

Director, Division of Infectious Diseases, Department of Medicine, Maimonides Medical Center

Reprints: Dr. Pastewski, Division of Infectious Diseases, Maimonides Medical Center, 4802 10th Ave., Brooklyn, NY 11219, fax 718/283-8813, andypaste{at}hotmail.com

BACKGROUND: Parenteral polymyxin use declined after the 1960s, due to safety concerns. An increase in multidrug-resistant (MDR) gram-negative infections and a shortage of new agents have prompted increased use of parenteral polymyxin.

OBJECTIVE: To describe our clinical experience with parenteral polymyxin B for MDR gram-negative bacteremia and urinary tract infection (UTI).

METHODS: Paper pharmacy records were used to identify patients aged 18 years or older, presence of MDR gram-negative bacteremia or UTI, and use of parenteral polymyxin B for at least 48 hours. Electronic and paper patient records were then retrospectively reviewed. Polymyxin B susceptibility was evaluated using the Kirby-Bauer method. MDR isolates were defined as resistant to at least 3 antimicrobial classes, excluding polymyxin B. Microbiologic clearance was defined by 1 repeat urine or 2 repeat blood cultures that were sterile or growing different organisms. Secondary outcomes included hospital mortality and nephrotoxicity, defined as an increase in serum creatinine of 0.5 mg/dL or more, or a 50% reduction in creatinine clearance.

RESULTS: Seventeen infections in 16 patients were treated with polymyxin B (1 pt. had 2 infections that were analyzed separately). Microbiologic clearance occurred in 14 of 16 (88%) cases of MDR gram-negative bacteremia or UTI in which repeat cultures were done. Ten of 16 patients died (all-cause mortality 63%). Five patients required hemodialysis prior to polymyxin B use. Six (55%) of the remaining 11 patients with baseline renal insufficiency developed nephrotoxicity, and none of them required hemodialysis. The mean ± SD number of days from the initiation of therapy to the onset of nephrotoxicity was 7.5 ± 2.3 (range 4–10) days. Three (50%) of 6 patients with nephrotoxicity died.

CONCLUSIONS: Our data suggest that polymyxin B may be effective for MDR gram-negative infections in patients with limited therapeutic options, but precautions should be taken to avoid toxicity.

Key Words: bacteremia, colistin, polymyxin B, urinary tract infection

Published Online, July 29, 2008. www.theannals.com, DOI 10.1345/aph.1K346

This article has been cited by other articles:

				C. A. Mendes, J. A Cordeiro, and E. A Burdmann Prevalence and Risk Factors for Acute Kidney Injury Associated with Parenteral Polymyxin B Use Ann. Pharmacother., December 1, 2009; 43(12): 1948 - 1955. [Abstract] [Full Text] [PDF]