title: Polymyxin B nephrotoxicity and efficacy against nosocomial infections caused by multiresistant gram-negative bacteria.
abstract: Reported rates of nephrotoxicity associated with the systemic use of polymyxins have varied widely. The emergence of infections due to multiresistant gram-negative bacteria has necessitated the use of systemic polymyxin B once again for the treatment of such infections. We retrospectively investigated the rate of nephrotoxicity in patients receiving polymyxin B parenterally for the treatment of infections caused by multiresistant gram-negative bacteria from October 1999 to September 2000. Demographic and clinical information was obtained for 60 patients. Outcome measures of interest were renal toxicity and clinical and microbiologic efficacy. Renal failure developed in 14% of the patients, all of whom had normal baseline renal function. Development of renal failure was independent of the daily and cumulative doses of polymyxin B and the length of treatment but was significantly associated with older age (76 versus 59 years, P = 0.02). The overall mortality was 20%, but it increased to 57% in those who developed renal failure. The organism was cleared in 88% of the patients from whom repeat specimens were obtained. The use of polymyxin B to treat multiresistant gram-negative infections was highly effective and associated with a lower rate of nephrotoxicity than previously described.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Saint Vincent's Hospital--Manhattan, New York, New York 10011, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Ouderkirk
authors.forename: Jill A
authors.initials: JA
authors.lastname: Nord
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Turett
authors.forename: Jay Ward
authors.initials: JW
authors.lastname: Kislak
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects; D058186:Acute Kidney Injury / Q000139:chemically induced / Q000503:physiopathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007674:Kidney Diseases / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000009:adverse effects* / Q000627:therapeutic use*; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents; D003404:Creatinine; D011112:Polymyxin B