title: Comparison of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia and tracheobronchitis caused by Pseudomonas aeruginosa or Acinetobacter baumannii.
abstract: OBJECTIVE
  This study was designed to compare the efficacy of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT) by Pseudomonas aeruginosa or Acinetobacter baumannii.
  
  
  METHODS
  A prospective cohort study was performed. Patients >18 years of age with the diagnosis of VAP or VAT who received appropriate therapy for >48 h were analyzed. The primary outcome was 30-day mortality. Clinical covariates were assessed and compared between the groups.
  
  
  RESULTS
  A total of 67 episodes were analyzed: 45 (67 %) treated with polymyxin B and 22 (33 %) with comparators. The crude 30-day mortality was 53 % (24 of 45) in the polymyxin B group and 27 % (6 of 22) in the comparator group (P = 0.08). Multivariable analysis using Cox regression models indicated that polymyxin B treatment was independently associated with increased mortality.
  
  
  CONCLUSIONS
  Polymyxin B treatment in the currently recommended dosage may be inferior to other drugs in the treatment of VAP and VAT caused by organisms tested as susceptible in vitro to this agent.
authors.affiliation: Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: M H
authors.initials: MH
authors.lastname: Rigatto
authors.forename: V B
authors.initials: VB
authors.lastname: Ribeiro
authors.forename: D
authors.initials: D
authors.lastname: Konzen
authors.forename: A P
authors.initials: AP
authors.lastname: Zavascki
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000188:drug therapy; D040981:Acinetobacter baumannii / Q000187:drug effects*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001991:Bronchitis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D003401:Creatine / Q000032:analysis; D052978:Disk Diffusion Antimicrobial Tests; D004341:Drug Evaluation / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011112:Polymyxin B / Q000008:administration & dosage / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D014136:Tracheitis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B; D003401:Creatine