Clinical outcomes associated with polymyxin B dose in patients with bloodstream infections due to carbapenem-resistant Gram-negative rods.
There is significant variation in the use of polymyxin B (PMB), and optimal dosing has not been defined. The purpose of this retrospective study was to evaluate the relationship between PMB dose and clinical outcomes. We included patients with bloodstream infections (BSIs) due to carbapenem-resistant Gram-negative rods who received ≥48 h of intravenous PMB. The objective was to evaluate the association between PMB dose and 30-day mortality, clinical cure at day 7, and development of acute kidney injury (AKI). A total of 151 BSIs were included. The overall 30-day mortality was 37.8% (54 of 151), and the median PMB dosage was 1.3 mg/kg (of total body weight)/day. Receipt of PMB dosages of <1.3 mg/kg/day was significantly associated with 30-day mortality (46.5% versus 26.3%; P = 0.02), and this association persisted in multivariable analysis (odds ratio [OR] = 1.58; 95% confidence interval [CI] = 1.05 to 1.81; P = 0.04). Eighty-two percent of patients who received PMB dosages of <1.3 mg/kg/day had baseline renal impairment. Clinical cure at day 7 was not significantly different between dosing groups. AKI was more common in patients receiving PMB dosages of ≥250 mg/day (66.7% versus 32.0%; P = 0.03), and this association persisted in multivariable analysis (OR = 4.32; 95% CI = 1.15 to 16.25; P = 0.03). PMB dosages of <1.3 mg/kg/day were administered primarily to patients with renal impairment, and this dosing was independently associated with 30-day mortality. However, dosages of ≥250 mg/day were independently associated with AKI. These data support the use of PMB without dose reduction in the setting of renal impairment.
NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA brn9016@nyp.org chk9005@nyp.org.
Brian C
BC
Nelson
NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
Daniel P
DP
Eiras
NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.
Angela
A
Gomez-Simmonds
NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
Angela S
AS
Loo
NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
Michael J
MJ
Satlin
NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
Stephen G
SG
Jenkins
NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.
Susan
S
Whittier
NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
David P
DP
Calfee
NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA.
E Yoko
EY
Furuya
NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, USA brn9016@nyp.org chk9005@nyp.org.
Christine J
CJ
Kubin
D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011112:Polymyxin B / Q000494:pharmacology*; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D011112:Polymyxin B