title: Nephrotoxicity and efficacy assessment of polymyxin use in 92 transplant patients.
abstract: Polymyxins are old antimicrobials, discontinued for many years because of nephrotoxicity and neurotoxicity reports and reintroduced recently due to the increasing frequency of multiresistant Gram-negative bacterial infections. There are very few data related to toxicity and efficacy from transplanted patients, the major subjects of this study. All solid-organ-transplanted patients from our institution during January 2001 to December 2007 who used polymyxins were retrospectively assessed for nephrotoxicity and treatment efficacy. Microbiological and clinical cure rates were 100% and 77.2%, respectively. Only transplant patients subjected to at least 72 h of intravenous polymyxin were entered in the study. Overall, 92 transplant patients were included, and the nephrotoxicity rate was 32.6%. Multivariate analysis showed a statistically significant association between duration of polymyxin treatment (P = 0.037; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00 to 1.12) and significant renal dysfunction. Polymyxin use is associated with very high rates of significant decrease in renal function; therefore, polymyxin must be used only when no other option is available and for as briefly as possible in the solid organ transplant setting.
authors.affiliation: Solid Organ Transplant Infectious Disease Unit, Infectious Disease Division, Federal University of São Paulo, São Paulo, Brazil. mm.mostardeiro@gmail.com
authors.forename: Marcelo M
authors.initials: MM
authors.lastname: Mostardeiro
authors.forename: Carlos A P
authors.initials: CA
authors.lastname: Pereira
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Jose O M
authors.initials: JO
authors.lastname: Pestana
authors.forename: Luis Fernando A
authors.initials: LF
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000633:toxicity*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000382:microbiology / Q000503:physiopathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation; D011112:Polymyxin B / Q000008:administration & dosage / Q000633:toxicity*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B