Effect of polymyxin B-containing regimens on renal function for the treatment of carbapenem-resistant Enterobacteriacea mediastinitis

Abboud, Cely Saad; Rao, Gauri G.; Souza, Ercilia E.; Zavascki, Alexandre P.; Kiffer, Carlos

doi:10.1016/j.bjid.2017.10.006

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Brazilian Journal of Infectious Diseases

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Sumário

Brief communications • Braz J Infect Dis 22 (1) • Jan-Feb 2018 • https://doi.org/10.1016/j.bjid.2017.10.006 copy

Effect of polymyxin B-containing regimens on renal function for the treatment of carbapenem-resistant Enterobacteriacea mediastinitis^☆ ☆ This study was partially presented as a poster at that 55th ICAAC 2015, 17–21, 2015 San Diego, CA, and as an oral presentation (Abstract O-3) at the 2nd International Conference on Polymyxins 2015, September 22–24 San Diego – CA.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

A retrospective cohort study, were evaluated: polymyxin B plus aminoglycosides or polymyxin B plus other antibiotics. Any degree of acute kidney injury occurred in 26 (86.6%) patients. The median time to acute kidney injury was 6.0 (95% CI 3–14) days in the polymyxin-aminoglycoside containing regimen group, against 27.0 (95% CI 6–42) days in the polymyxin with other antimicrobial combinations group (p = 0.03). Polymyxin B with aminoglycosides group progressed faster to any degree of renal dysfunction.

Keywords:
AKI; CRE; Polymyxins; Aminoglicosides

Patient demographics	Total n = 30	Polymyxin B plus other antimicrobials n = 11	Polymyxin B plus aminoglycoside/other n = 19	p-Value
Female sex, n (%)	12 (40)	4 (36.4)	8 (42.1)	1.00
Race White, n (%)	23 (76.7)	8 (72.7)	15 (79)	1.00
Body mass index (BMI) mean (SD)	30	31.44 (8.10)	30.41 (7.68)	0.735
BMI > 30, n (%)	12 (40)	4 (36.3)	8 (42.1)	1.00
APACHE Index (AI) when CRE treatment starts/No. patients (P)	13 (P) (43.33%)	12 (AI) 4 (P)	15.78 (AI) 9 (P)	0.414
Creatinine (mg/dL) before surgery mean (SD)	30	0.90 (0.30)	1.11 (0.44)	0.268
ICU stay before CRE mediastinitis, n (%)	14 (46.6%)	4 (36.4%)	10 (52.6%)	0.466
CRE mediastinitis	30	11	19
Total Polymyxin Resistant (PR-CRE)	12	2 (18.2%)	10 (52.6%)	0.121
Treatment
Polymyxin B, n (%)	30	11	19
Length of treatment (days)	30 (P)	44 days	25 days	0.019
Total doses/day IU
Median	1,500,000	1,500,000	1,500,000	0.215
Minimal	750,000	1,300,000	750,000
Maximum	3,200,000	3,200,000	2,200,000
Aminoglycosides, n (%)	19 (63.3)	-	19
Length of treatment median mean range (days)	-	-	20 (6-45)
Patients any AKI degree - n	26	9	17
End Stage Renal disease		1 (9.1%)	5 (26.3%)	0.372
Mean time to AKI in days	-	27 days	6 days	0.03 (CI 95% 3-14)
Complete renal function recovery after treatment (SCr < 1.5 mg/dL), n (%)	9 (45)	5 (62.5)	4 (33)	0.36
In-hospital mortality	11 (36.6%)	1 (9.1%)	10 (52.6%)	0.023

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[1] *Corresponding author. cely.saad@gmail.com