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Wu T, Shi Y, Xu C, Zhu B, Li D, Li Z, Zhao Z, Zhang Y. A pharmacovigilance study of adverse events associated with polymyxins based on the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Expert Opin Drug Saf 2024:1-9. [PMID: 38676603 DOI: 10.1080/14740338.2024.2348610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/19/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Polymyxins have been regarded as last-line treatment for multidrug-resistant gram-negative bacterial infections. Nonetheless, concerns regarding toxicity persist. This study aimed to explore and compare potential adverse events (AEs) between colistin and polymyxin B (PMB). METHODS Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study Polymyxins-related AEs were retrieved from the U.S. Food and Drug Administration Adverse Event Reporting System between 2004 and 2022. Potential signals were estimated by the reporting odds ratio (ROR), and subgroup analyses were preformed to adjust for potential factors in AEs with significant disproportionality. RESULTS Analysis of 3,915 records involving 718 patients revealed a higher disproportionality of renal and urinary disorders (ROR 1.62, 95% CI 1.01-2.59) and acute kidney injury (ROR 1.75, 95% CI 1.07-2.87) with colistin treatment. Conversely, colistin exhibited a lower risk for neurotoxicity (ROR 0.47, 95% CI 0.30-0.73). Seven cases of skin hyperpigmentation were reported with PMB, whereas none were reported with colistin. Over 80% of cases involving polymyxin-related AEs occurred during the first two weeks of therapies, with a median onset time of 4.5 days. CONCLUSIONS Outpatient antibiotic use associated with acute upper respiratory infections in China: a nationwide cross-sectional study Patients received colistin displayed a higher potential risk of nephrotoxicity but a lower risk of neurotoxicity. Clinicians should be vigilant in monitoring the AEs of hyperpigmentation disorders induced by PMB.
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Affiliation(s)
- Tingxi Wu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yanfeng Shi
- Center of excellence for Omics Research, National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chang Xu
- Clinical Trials Institutions for Drugs and Medical devices, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Bin Zhu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dandan Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhe Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhigang Zhao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery Systems, State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
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Tiwari AK, Gupta MK, Meena R, Pandey PC, Narayan RJ. Molecular Weights of Polyethyleneimine-Dependent Physicochemical Tuning of Gold Nanoparticles and FRET-Based Turn-On Sensing of Polymyxin B. Sensors (Basel) 2024; 24:2169. [PMID: 38610380 PMCID: PMC11014186 DOI: 10.3390/s24072169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024]
Abstract
Environmental monitoring and the detection of antibiotic contaminants require expensive and time-consuming techniques. To overcome these challenges, gold nanoparticle-mediated fluorometric "turn-on" detection of Polymyxin B (PMB) in an aqueous medium was undertaken. The molecular weight of polyethyleneimine (PEI)-dependent physicochemical tuning of gold nanoparticles (PEI@AuNPs) was achieved and employed for the same. The three variable molecular weights of branched polyethyleneimine (MW 750, 60, and 1.3 kDa) molecules controlled the nano-geometry of the gold nanoparticles along with enhanced stabilization at room temperature. The synthesized gold nanoparticles were characterized through various advanced techniques. The results revealed that polyethyleneimine-stabilized gold nanoparticles (PEI@AuNP-1-3) were 4.5, 7.0, and 52.5 nm in size with spherical shapes, and the zeta potential values were 29.9, 22.5, and 16.6 mV, respectively. Accordingly, the PEI@AuNPs probes demonstrated high sensitivity and selectivity, with a linear relationship curve over a concentration range of 1-6 μM for polymyxin B. The limit of detection (LOD) was calculated as 8.5 nM. This is the first unique report of gold nanoparticle nano-geometry-dependent FRET-based turn-on detection of PMB in an aqueous medium. We believe that this approach would offer a complementary strategy for the development of a highly sophisticated and advanced sensing system for PMB and act as a template for the development of new nanomaterial-based engineered sensors for rapid antibiotic detection in environmental as well as biological samples.
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Affiliation(s)
- Atul Kumar Tiwari
- Department of Chemistry, Indian Institute of Technology, Banaras Hindu University, Varanasi 221005, India;
| | - Munesh Kumar Gupta
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India;
| | - Ramovatar Meena
- School of Environmental Science, Jawaharlal Nehru University, New Delhi 110067, India;
| | - Prem C. Pandey
- Department of Chemistry, Indian Institute of Technology, Banaras Hindu University, Varanasi 221005, India;
| | - Roger J. Narayan
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, NC 27695, USA
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Ballı FN, Ekinci PB, Kurtaran M, Kara E, Dizman GT, Sönmezer MÇ, Hayran M, Demirkan K, Metan G. Battle of polymyxin induced nephrotoxicity: Polymyxin B versus colistin. Int J Antimicrob Agents 2024; 63:107035. [PMID: 37979889 DOI: 10.1016/j.ijantimicag.2023.107035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVES Nephrotoxicity is the most serious and common adverse effect that limits the use of polymyxins. This study compared polymyxin E (colistin) and polymyxin B regarding drug-related nephrotoxicity. METHODS This study was conducted as a retrospective cohort study in a university hospital between January 2020 and July 2022. Patients older than 18 years and who received colistin or polymyxin B were identified using electronic hospital records. Kidney disease improving global outcome criteria were used for assessing nephrotoxicity. RESULTS A total of 190 patients, 95 in both groups, were evaluated. The incidence of acute kidney injury during the treatment was higher in the colistin group [52.6% (n = 50) and 34.7% (n = 33), P = 0.013]. In patients who were exposed to high-dose, the rate of nephrotoxicity was higher in patients receiving colistin [25% (n = 3) vs. 76.9% (n = 10); P = 0.017]. Nephrotoxicity was reversible in 64.4% (n = 38) of patients and the reversibility rate was similar (70% and 52.6% for colistin and polymyxin; P = 0.248). In the multivariable analysis, colistin treatment [odds ratio (OR): 3.882, 95% confidence interval (95% CI) = (1.829-8.241)], concomitant vasopressor use (OR = 2.08, CI: 1.036-4.179), and age (OR=1.036, CI: 1.014-1.058) were found to be independent markers of nephrotoxicity. CONCLUSION Nephrotoxicity was more common in patients receiving high-dose colistin than polymyxin B. Therefore, the use of appropriate doses of colistin is important in terms of preventing nephrotoxicity. In addition, advancing age and concomitant use of vasopressors contribute to polymyxin-related nephrotoxicity.
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Affiliation(s)
- Fatma Nisa Ballı
- Department of Clinical Pharmacy, Gazi University Faculty of Pharmacy, Ankara, Türkiye; Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Türkiye.
| | - Pınar Bakır Ekinci
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Türkiye
| | - Melek Kurtaran
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Türkiye
| | - Emre Kara
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Türkiye
| | - Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Meliha Çağla Sönmezer
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Mutlu Hayran
- Department of Preventive Oncology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Türkiye
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Lodise TP, Yucel E, Obi EN, Watanabe AH, Nathanson BH. Incidence of acute kidney injury (AKI) and its impact on patient outcomes among adult hospitalized patients with carbapenem-resistant Gram-negative infections who received targeted treatment with a newer β-lactam or β-lactam/β-lactamase inhibitor-, polymyxin- or aminoglycoside-containing regimen. J Antimicrob Chemother 2024; 79:82-95. [PMID: 37962080 PMCID: PMC10761276 DOI: 10.1093/jac/dkad351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Limited comparative data exist on acute kidney injury (AKI) risk and AKI-associated outcomes in hospitalized patients with carbapenem-resistant Gram-negative infections (CR-GNIs) treated with a newer β-lactam/β-lactam-β-lactamase inhibitor (BL/BL-BLI)-, polymyxin (PB)- or aminoglycoside (AG)-containing regimen. This study quantified the risk of AKI and AKI-related outcomes among patients with CR-GNIs treated with a newer BL/BL-BLI-, PB- or AG-containing regimen. METHODS A multicentre, retrospective, observational study was performed (2016-20). The study included adult hospitalized patients with (i) baseline estimated glomerular filtration rates ≥30 mL/min/1.73 m2; (ii) CR-GN pneumonia, complicated urinary tract infection or bloodstream infection; and (iii) receipt of newer BL/BL-BLI, PG or AG within 7 days of index CR-GN culture for ≥3 days. Outcomes included AKI, in-hospital mortality and hospital costs. RESULTS The study included 750 patients and most (48%) received a newer BL/BL-BLI. The median (IQR) treatment duration was 8 (5-11), 5 (4-8) and 7 (4-8) days in the newer BL/BL-BLI group, AG group and PB group, respectively. The PB group had the highest adjusted AKI incidence (95% CI) (PB: 25.1% (15.6%-34.6%) versus AG: 8.9% (5.7%-12.2%) versus newer BL/BL-BLI: 11.9% (8.1%-15.7%); P = 0.001). Patients with AKI had significantly higher in-hospital mortality (AKI: 18.5% versus 'No AKI': 5.6%; P = 0.001) and mean hospital costs (AKI: $49 192 versus 'No AKI': $38,763; P = 0.043). CONCLUSIONS The AKI incidence was highest among PB patients and patients with AKI had worse outcomes. Healthcare systems should consider minimizing the use of antibiotics that augment AKI risk as a measure to improve outcomes in patients with CR-GNIs.
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Affiliation(s)
- Thomas P Lodise
- Albany College of Pharmacy and Health Sciences, Department of Pharmacy Practice, 106 New Scotland Avenue, Albany, NY, USA
| | - Emre Yucel
- Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, USA
| | - Engels N Obi
- Merck & Co., Inc., 2025 E Scott Ave, Rahway, NJ, USA
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Zhang Y, Dong R, Huang Y, Ling X, Ye Z, Jiang S. Acute kidney injury associated with colistin sulfate vs. polymyxin B sulfate therapy: A real-world, retrospective cohort study. Int J Antimicrob Agents 2024; 63:107031. [PMID: 37951480 DOI: 10.1016/j.ijantimicag.2023.107031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To compare the incidence of acute kidney injury (AKI) in patients treated with colistin sulfate (CS) and polymyxin B sulfate (PMB). METHODS Sociodemographic and laboratory measures of adult patients who received intravenous CS or PMB for at least 72 h for the first time at the study hospital from October 2021 to November 2022 were collected retrospectively. The primary outcome was the incidence of AKI, defined by the Kidney Diseases Improving Global Outcomes criteria. The secondary outcome was 30-day mortality. RESULTS In total, 109 patients were included in the CS cohort and 176 patients were included in the PMB cohort. The incidence of AKI was significantly higher in the PMB cohort compared with the CS cohort (50.6% vs. 18.3%; P<0.001). On multi-variate analysis, CS therapy [hazard ratio (HR) 0.275; P<0.001] was an independent protective factor for AKI, along with higher estimated glomerular filtration rate. Nevertheless, 30-day mortality was similar in the PMB and CS cohorts (21.6% vs. 13.8%; P=0.099). Multi-variate analyses revealed that CS therapy was not associated with 30-day mortality (HR 0.968; P=0.926), while intensive care unit admission, combination with meropenem, Charlson score and stage 3 AKI were independent risk factors for 30-day mortality. After balancing the baseline characteristics of patients using propensity score matching, the main results were unchanged. CONCLUSION The incidence of AKI was significantly lower in the CS cohort compared with the PMB cohort. However, 30-day mortality was similar in the two cohorts.
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Affiliation(s)
- Yanfang Zhang
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rong Dong
- Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yizhen Huang
- Department of Pharmacy, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang, China
| | - Xiao Ling
- Department of Pharmacy, The People's Hospital of Yuhuan, Taizhou, Zhejiang, China
| | - Ziqi Ye
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Saiping Jiang
- Department of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Wu Y, Jiang S, Li D, Wu Y, Li Q, Wang X, Liu B, Bao H, Wu D, Hu X. Clinical Efficacy and Safety of Colistin Sulfate in the Treatment of Carbapenem-Resistant Organism Infections in Patients with Hematological Diseases. Infect Dis Ther 2024; 13:141-154. [PMID: 38212555 PMCID: PMC10828183 DOI: 10.1007/s40121-023-00909-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Carbapenem-resistant organisms (CRO) have emerged as a significant worldwide issue. However, the availability of efficacious antibiotics for treating CRO infections remains limited. Polymyxins, including colistin sulfate, represent the last-line therapeutic option against CRO infections. This study aims to retrospectively evaluate the clinical effectiveness and safety of colistin sulfate in managing CRO infections among patients with hematological diseases. METHODS Between April 2022 and January 2023, a total of 118 hematological patients diagnosed with CRO infection were treated with colistin sulfate at Suzhou Hongci Hospital of Hematology. The assessment encompassed the clinical efficacy, bacterial clearance rate, adverse reactions, and 30-day all-cause mortality. RESULTS The study found that the total effective rate of colistin sulfate in the treatment of CRO infection was 74.6%, with a bacterial clearance rate of 72.6%. Throughout the treatment, nephrotoxicity occurred in 7.6% of cases, neurotoxicity in 2.5% of cases, and the 30-day all-cause mortality rate was 22.9%. Multivariate logistic analysis revealed that the treatment course and combination medication with other antimicrobials were independent factors affecting the clinical efficacy of colistin sulfate. CONCLUSION Our study demonstrates that the treatment of colistin sulfate can achieve high clinical efficacy and microbial responses, with a low risk of nephrotoxicity. This study provides evidence of the positive clinical efficacy and safety of colistin sulfate treatment in these patients. High-quality randomized controlled trials are still needed to further confirm the beneficial role of colistin sulfate.
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Affiliation(s)
- Yuanbing Wu
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Shanshan Jiang
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Dongyang Li
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Yaxue Wu
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Qian Li
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Xing Wang
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Bin Liu
- Department of Hematology, The Hospital of Suzhou Hongci Hematology, Suzhou, 215000, Jiangsu, China
| | - Haiyan Bao
- Department of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China
| | - Depei Wu
- Department of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.
| | - Xiaohui Hu
- Department of Hematology, National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.
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Karimzadeh I, Strader M, Kane-Gill SL, Murray PT. Prevention and management of antibiotic associated acute kidney injury in critically ill patients: new insights. Curr Opin Crit Care 2023; 29:595-606. [PMID: 37861206 DOI: 10.1097/mcc.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Drug associated kidney injury (D-AKI) occurs in 19-26% of hospitalized patients and ranks as the third to fifth leading cause of acute kidney injury (AKI) in the intensive care unit (ICU). Given the high use of antimicrobials in the ICU and the emergence of new resistant organisms, the implementation of preventive measures to reduce the incidence of D-AKI has become increasingly important. RECENT FINDINGS Artificial intelligence is showcasing its capabilities in early recognition of at-risk patients for acquiring AKI. Furthermore, novel synthetic medications and formulations have demonstrated reduced nephrotoxicity compared to their traditional counterparts in animal models and/or limited clinical evaluations, offering promise in the prevention of D-AKI. Nephroprotective antioxidant agents have had limited translation from animal studies to clinical practice. The control of modifiable risk factors remains pivotal in avoiding D-AKI. SUMMARY The use of both old and new antimicrobials is increasingly important in combating the rise of resistant organisms. Advances in technology, such as artificial intelligence, and alternative formulations of traditional antimicrobials offer promise in reducing the incidence of D-AKI, while antioxidant medications may aid in minimizing nephrotoxicity. However, maintaining haemodynamic stability using isotonic fluids, drug monitoring, and reducing nephrotoxic burden combined with vigilant antimicrobial stewardship remain the core preventive measures for mitigating D-AKI while optimizing effective antimicrobial therapy.
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Affiliation(s)
- Iman Karimzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Michael Strader
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sandra L Kane-Gill
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh
- Department of Pharmacy, UPMC, Pittsburgh, Pennsylvania, USA
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
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Xia GL, Xu X, You XB, Wang X, Feng DD, Lei S, Jiang RL. Efficacy and nephrotoxicity of polymyxin B in elderly patients with carbapenem resistant bacterial infection. Ann Clin Microbiol Antimicrob 2023; 22:101. [PMID: 37968642 PMCID: PMC10652515 DOI: 10.1186/s12941-023-00647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND To study the efficacy and nephrotoxicity of polymyxin B in the treatment of elderly patients with carbapenem-resistant organism (CRO) infection. METHODS The clinical and microbiological data of patients with CRO-infected sepsis treated with polymyxin B were retrospectively analyzed. The effective rate, bacterial clearance, incidence and recovery rate of acute renal injury (AKI) and prognosis-related indicators in AKI at different stages were compared. RESULTS The effective rate of 215 elderly patients with CRO infection treated with polymyxin was 50.7%. The total bacterial clearance rate was 44.2%, the total incidence of AKI was 37.2%, the recovery rate of AKI was 35%, and the incidence range of polymyxin B-related AKI was 10.2-37.2%. Logistic multivariate regression analysis showed that the predictors of AKI in elderly patients were high APACHE II score, long duration of polymyxin, chronic renal insufficiency and ineffective outcome; the ROC curve showed that the cutoff value for predicting AKI was a serum creatinine concentration of 73 mmol/L before polymyxin B use, and the AUC was 0.931. CONCLUSIONS Rational use of polymyxin B is safe and effective in elderly patients with CRO infection, and its effective outcome can improve the recovery rate of AKI.
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Affiliation(s)
- G L Xia
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), NO.54 Youdian Road, Hangzhou, 310006, China
| | - X Xu
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - X B You
- The Third Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, 310009, China
| | - X Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), NO.54 Youdian Road, Hangzhou, 310006, China
| | - D D Feng
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), NO.54 Youdian Road, Hangzhou, 310006, China
| | - S Lei
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), NO.54 Youdian Road, Hangzhou, 310006, China
| | - R L Jiang
- Department of Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), NO.54 Youdian Road, Hangzhou, 310006, China.
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Yu M, Li H, Wang B, Wu Z, Wu S, Jiang G, Wang H, Huang Y. Baicalein ameliorates polymyxin B-induced acute renal injury by inhibiting ferroptosis via regulation of SIRT1/p53 acetylation. Chem Biol Interact 2023; 382:110607. [PMID: 37354967 DOI: 10.1016/j.cbi.2023.110607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/04/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
The polypeptide antibiotic Polymyxin B (PMB) can cause acute kidney injury (AKI), we found that ferroptosis is one of the main mechanisms of renal injury caused by PMB. It was reported that baicalein can inhibit ferroptosis. Therefore, in this study we examined whether baicalein could attenuate PMB-induced renal injury by inhibiting ferroptosis. We confirmed that baicalein could reduce PMB-induced renal injury in vivo and in vitro studies. In the in vitro study, baicalein significantly increased the survival rate of human HK2 tubular epithelial cells. The results of HE staining and electron microscopy in mice also showed that baicalein reduced PMB-induced renal injury, and significantly decreased the levels of BUN and Scr. By detecting ferroptosis-related indicators, we found that pre-incubation of baicalein in HK2 cells down-regulated Fe2+ level, lipid peroxidation, MDA and HO-1 which had been increased by PMB. Furthermore, baicalein up-regulated the levels of SCL7A11, GPX4 and GSH that were decreased by PMB. Moreover, intraperitoneal injection of baicalein in the animal model down-regulated kidney iron level, PTGS2 and 4HNE, and increased the GSH level, which suggested that baicalein could inhibit PMB-induced ferroptosis. Finally, by detecting changes in levels of p53 and p53 K382 acetylation, baicalein was observed to decrease elevated p53 K382 acetylation after PMB treatment, further confirming that baicalein inhibits ferroptosis by reducing p53 K382 acetylation via upregulation of SIRT1 expression. In conclusion, these results suggest that baicalein decreases p53 acetylation level by elevating SIRT1, which can then inhibit PMB-induced ferroptosis and ultimately attenuates AKI.
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Affiliation(s)
- Meiling Yu
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui, 233004, PR China; Faculty of Pharmacy, Bengbu Medical College, 2600 Donghai Road, Bengbu, Anhui, 233003, PR China; Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, PR China
| | - Hongyu Li
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui, 233004, PR China; Faculty of Pharmacy, Bengbu Medical College, 2600 Donghai Road, Bengbu, Anhui, 233003, PR China
| | - Boying Wang
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui, 233004, PR China; Faculty of Pharmacy, Bengbu Medical College, 2600 Donghai Road, Bengbu, Anhui, 233003, PR China
| | - Zhenxiang Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, PR China
| | - Sheng Wu
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui, 233004, PR China; Faculty of Pharmacy, Bengbu Medical College, 2600 Donghai Road, Bengbu, Anhui, 233003, PR China
| | - Guojun Jiang
- Faculty of Pharmacy, Bengbu Medical College, 2600 Donghai Road, Bengbu, Anhui, 233003, PR China
| | - Huaxue Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, PR China.
| | - Yingying Huang
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui, 233004, PR China; Faculty of Pharmacy, Bengbu Medical College, 2600 Donghai Road, Bengbu, Anhui, 233003, PR China.
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Garcia RCL, Rodrigues RD, Garcia ECL, Rigatto MH. Comparison between Colistin and Polymyxin B in the Treatment of Bloodstream Infections Caused by Carbapenem-Resistant Pseudomonas aeruginosa and Acinetobacter baumannii-calcoaceticus Complex. Antibiotics (Basel) 2023; 12:1317. [PMID: 37627737 PMCID: PMC10451820 DOI: 10.3390/antibiotics12081317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Polymyxins are still widely used for the treatment of carbapenem-resistant Acinetobacter baumannii and Pseudomonas aeruginosa bloodstream infections (BSIs). This study seeks to evaluate the impact of polymyxin B versus colistin on mortality and nephrotoxicity in BSI caused by these bacteria. We conducted a retrospective cohort study from 2014 to 2021 in Porto Alegre, Brazil. We included patients aged ≥18 years and excluded patients with polymicrobial infection or treatment for ≤48 h. The 30-day mortality was the primary outcome evaluated through Cox regression. We included 259 patients with BSI episodes: 78.8% caused by A. baumannii and 21.2% caused by P. aeruginosa. Polymyxin B did not impact mortality compared to colistin (adjusted hazard ratio (aHR), 0.82; 95% confidence interval (CI), 0.52-1.30; p = 0.40 (when adjusted for COVID-19 comorbidity, p = 0.05), Pitt bacteremia score, p < 0.01; Charlson comorbidity index, p < 0.001; time to start active antimicrobial therapy, p = 0.02). Results were maintained in the subgroups of BSI caused by A. baumannii (aHR, 0.92; 95% CI, 0.55-1.54; p = 0.74), P. aeruginosa (aHR, 0.47; 95% CI, 0.17-1.32; p = 0.15) and critical care patients (aHR, 0.77; 95% CI, 0.47-1.26; p = 0.30). Treatment with polymyxin B or colistin did not impact 30-day mortality in patients with carbapenem-resistant A. baumannii or P. aeruginosa BSI.
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Affiliation(s)
| | - Rodrigo Douglas Rodrigues
- Healthcare-Associated Infection Control Service, Hospital Universitário Professor Polydoro Ernani de São Thiago, Universidade Federal de Santa Catarina, Florianópolis 88036-800, Brazil;
| | | | - Maria Helena Rigatto
- Medical Sciences Post-Graduation Program, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil;
- Internal Medicine Department, School of Medicine of the Federal University of Rio Grande do Sul, Porto Alegre 90035-903, Brazil
- Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Porto Alegre 90035-903, Brazil
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11
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Lee H, Kim B, Kim M, Yoo S, Lee J, Hwang E, Kim Y. Characterization of the Antimicrobial Activities of Trichoplusia ni Cecropin A as a High-Potency Therapeutic against Colistin-Resistant Escherichia coli. Pharmaceutics 2023; 15:1752. [PMID: 37376200 DOI: 10.3390/pharmaceutics15061752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
The spread of colistin-resistant bacteria is a serious threat to public health. As an alternative to traditional antibiotics, antimicrobial peptides (AMPs) show promise against multidrug resistance. In this study, we investigated the activity of the insect AMP Tricoplusia ni cecropin A (T. ni cecropin) against colistin-resistant bacteria. T. ni cecropin exhibited significant antibacterial and antibiofilm activities against colistin-resistant Escherichia coli (ColREC) with low cytotoxicity against mammalian cells in vitro. Results of permeabilization of the ColREC outer membrane as monitored through 1-N-phenylnaphthylamine uptake, scanning electron microscopy, lipopolysaccharide (LPS) neutralization, and LPS-binding interaction revealed that T. ni cecropin manifested antibacterial activity by targeting the outer membrane of E. coli with strong interaction with LPS. T. ni cecropin specifically targeted toll-like receptor 4 (TLR4) and showed anti-inflammatory activities with a significant reduction of inflammatory cytokines in macrophages stimulated with either LPS or ColREC via blockade of TLR4-mediated inflammatory signaling. Moreover, T. ni cecropin exhibited anti-septic effects in an LPS-induced endotoxemia mouse model, confirming its LPS-neutralizing activity, immunosuppressive effect, and recovery of organ damage in vivo. These findings demonstrate that T. ni cecropin exerts strong antimicrobial activities against ColREC and could serve as a foundation for the development of AMP therapeutics.
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Affiliation(s)
- Hyeju Lee
- Department of Bioscience and Biotechnology, Konkuk University, Seoul 05029, Republic of Korea
| | - Byeongkwon Kim
- Department of Bioscience and Biotechnology, Konkuk University, Seoul 05029, Republic of Korea
| | - Minju Kim
- Department of Bioscience and Biotechnology, Konkuk University, Seoul 05029, Republic of Korea
| | - Seoyeong Yoo
- Department of Bioscience and Biotechnology, Konkuk University, Seoul 05029, Republic of Korea
| | - Jinkyeong Lee
- Department of Bioscience and Biotechnology, Konkuk University, Seoul 05029, Republic of Korea
| | - Eunha Hwang
- Center for Research Equipment, Korea Basic Science Institute, Cheongju 28119, Republic of Korea
| | - Yangmee Kim
- Department of Bioscience and Biotechnology, Konkuk University, Seoul 05029, Republic of Korea
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12
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Wang J, Shah BK, Zhao J, Xiong J, Wang C, Xie S. Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB. BMC Infect Dis 2023; 23:351. [PMID: 37231342 DOI: 10.1186/s12879-023-08339-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND With the difficulties in choosing colistin sulfate and polymyxin B sulfate (PBS) for carbapenem-resistant gram-negative bacteria (CR-GNB), we compared the efficacy and safety of these two old polymyxins in treatment of critically ill patients infected with CR-GNB infection. METHODS One hundred four patients infected with CR-GNB in ICU were retrospectively grouped by PBS (68 patients) or colistin sulfate (36 patients). Clinical efficacy including symptoms, inflammatory parameters, defervescence, prognosis and microbial efficacy were analyzed. Hepatotoxicity, nephrotoxicity, and hematotoxicity were evaluated by TBiL, ALT, AST, creatinine, and thrombocytes. RESULTS Demographic characteristics between colistin sulfate and PBS were not significantly different. Most of the CR-GNB were cultured in respiratory tract (91.7% vs 86.8%), and almost all were polymyxin-sensitive (98.2% vs 100%, MIC ≤ 2 μg/ml). The microbial efficacy in colistin sulfate (57.1%) was significantly higher than PBS (30.8%) (p = 0.022), however, no significant difference in clinical success was seen in both groups (33.8% vs 41.7%), as well as mortality, defervescence, imaging remission, days in the hospital, microbial reinfections, and prognosis, and almost all patients defervesce within 7 days (95.6% vs 89.5%). CONCLUSIONS Both polymyxins can be administrated in critically ill patients infected with CR-GNB and colistin sulfate is superior to PBS in microbial clearance. These results highlight the necessity of identifying CR-GNB patients who may benefit from polymyxin and who are at higher risk of mortality.
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Affiliation(s)
- Jiale Wang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Binay Kumar Shah
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
- Tongji University School of Medicine, Shanghai, 200092, China
| | - Jian Zhao
- Department of Emergency Medicine, Shanghai Tenth People'S Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Jie Xiong
- Department of Respiratory Medicine, ChongMing Branch of Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 202157, China
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
| | - Shuanshuan Xie
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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13
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Rabi R, Enaya A, Sweileh MW, Aiesh BM, Namrouti A, Hamdan ZI, Abugaber D, Nazzal Z. Comprehensive Assessment of Colistin Induced Nephrotoxicity: Incidence, Risk Factors and Time Course. Infect Drug Resist 2023; 16:3007-3017. [PMID: 37215302 PMCID: PMC10198178 DOI: 10.2147/idr.s409964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose In recent years, the emergence of multidrug-resistant (MDR) microorganisms had caused the resurgence of colistin use after it was previously abandoned due to its side effects, nephrotoxicity in particular. However, the specific incidence of colistin-induced nephrotoxicity varies in reports with different populations. This study aims to assess the incidence of colistin-associated nephrotoxicity and the associated risk factors. Patients and Methods This study was on 178 patients who received colistin for more than 48 hours during the years 2019-2022, who were followed up for 14 days after the initiation of colistin, and demographic and clinical data were gained from medical reports. Logistic regression was used to assess the relationship between nephrotoxicity and study variables. Results The incidence of nephrotoxicity was 44.9% (95% confidence interval (CI); 37% to 53%), and the overall mortality was 33%, with a significantly higher level among patients with nephrotoxicity. The significant risk factors for nephrotoxicity after adjustment were; higher weights (OR = 1.1, 95% CI; 0.03-1.2), P-value: 0.006, and the combination with carbapenem showed a significant protective effect (OR = 0.09, 95% CI; 0.01-0.8), P-value: 0.03. The severity, according to KDIGO classification, was stage 1 (47%), stage 2 (21%), and stage 3 (31%). Higher stages had earlier onset acute kidney injury, a lower percentage of returning to baseline, and exposure to a higher colistin dose. Conclusion Colistin-induced nephrotoxicity was a frequent issue associated with higher weights, mitigated by the combination with carbapenems. While higher colistin dosages, and earlier onset AKI, were linked to the progression to higher AKI stages and the need for dialysis.
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Affiliation(s)
- Razan Rabi
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Ahmad Enaya
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Mamoun W Sweileh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Banan M Aiesh
- Infection Control Department, An-Najah National University Hospital, Nablus, Palestine
| | - Ashraqat Namrouti
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Zakaria I Hamdan
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Dina Abugaber
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Zaher Nazzal
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Li H, Wang B, Wu S, Dong S, Jiang G, Huang Y, Tong X, Yu M. Ferroptosis is involved in polymyxin B-induced acute kidney injury via activation of p53. Chem Biol Interact 2023; 378:110479. [PMID: 37088170 DOI: 10.1016/j.cbi.2023.110479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023]
Abstract
Polymyxin B (PMB) is one of the most effective drugs for the treatment of multi-resistant and pan-resistant gram-negative infections. However, it can induce acute kidney injury (AKI), the mechanism of which has not yet been fully elucidated. In this study, RNA sequencing and in vitro and in vivo experiments demonstrated that PMB induced AKI by promoting ferroptosis. Moreover, the metallothionein-1 (MT-1) level was significantly increased in the AKI group and clinical cases revealed that iron and MT-1 levels in urine were significantly higher in patients with AKI than in those without AKI. To explore the mechanism of PMB induced ferroptosis, we silenced p53 in human kidney-2 (HK2) cells according to RNA sequencing, which showed that p53 was obviously enhanced in the PMB treated group. While PMB significantly enhanced Fe2+, lipid peroxidation, malondialdehyde (MDA), transferrin receptor protein 1 (TFR1), and arachidonate 12-lpoxygenase (ALOX12), decreased the survival rate, solute carrier family 7 member 11 (SLC7A11), glutathione peroxidase 4 (GPX4), and glutathione (GSH), downregulation of p53 reversed these effects, suggesting PMB induced ferroptosis by activating p53. Studies have shown p53 can promote ferroptosis by regulating the downstream factors SLC7A11 or TFR1. Further, we verified that silencing TFR1 expression as well as overexpression of SLC7A11 inhibited ferroptosis and significantly increased the survival rate of HK2 cells. Overall, PMB induces ferroptosis in renal tubular cells by activating p53 to reduce SLC7A11 expression and elevate TFR1, leading to AKI; MT-1 and iron levels in urine were significantly increased when PMB induced ferroptosis.
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Affiliation(s)
- Hongyu Li
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, People's Republic of China; Faculty of Pharmacy, Bengbu Medical College, Anhui, Bengbu, 233030, People's Republic of China; Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, People's Republic of China
| | - Boying Wang
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, People's Republic of China; Faculty of Pharmacy, Bengbu Medical College, Anhui, Bengbu, 233030, People's Republic of China
| | - Sheng Wu
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, People's Republic of China; Faculty of Pharmacy, Bengbu Medical College, Anhui, Bengbu, 233030, People's Republic of China
| | - Shuying Dong
- Faculty of Pharmacy, Bengbu Medical College, Anhui, Bengbu, 233030, People's Republic of China
| | - Guojun Jiang
- Faculty of Pharmacy, Bengbu Medical College, Anhui, Bengbu, 233030, People's Republic of China
| | - Yingying Huang
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, People's Republic of China; Faculty of Pharmacy, Bengbu Medical College, Anhui, Bengbu, 233030, People's Republic of China
| | - Xuhui Tong
- Faculty of Pharmacy, Bengbu Medical College, Anhui, Bengbu, 233030, People's Republic of China.
| | - Meiling Yu
- Department of Pharmacy, The First Affiliated Hospital of Bengbu Medical College, Anhui, Bengbu, 233004, People's Republic of China; Faculty of Pharmacy, Bengbu Medical College, Anhui, Bengbu, 233030, People's Republic of China; Department of Pharmacy, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, People's Republic of China.
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15
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Liu Z, Shi Y, Li C, Hu W, Yao Z. Ratiometric detection of polymyxin B based on the disaggregation of pyrenyl nanoassemblies in 100% aqueous media. Spectrochim Acta A Mol Biomol Spectrosc 2023; 284:121781. [PMID: 36063737 DOI: 10.1016/j.saa.2022.121781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Polymyxin B (PMB) was an antibiotic with highly effective antibacterial effect but narrow safety interval, and its residues in food had attracted widespread attention. It was important to develop an accurate method for the rapid detection of PMB in animal foods. In this work, we had established a ratiometric sensing system based on the formation of supramolecular assemblies of pyrenyl probes, which were driven by the synergy of noncovalent forces such as multiple-electrostatic and π-π stacking interactions. Compared with the traditional fluorescence detection based on the single wavelength change, the present approach showing two-wavelength fluorescence response could reduce the interference of other factors making the experimental results more accurate. The sensor exhibited high sensitivity and selectivity with a low detection limit (28.3 nM). This method could be used to realize visual detection and had a visual detection limit of 1 μM. As we had learned yet, this was the first ratiometric sensor for PMB detection in aqueous solution. We believed all our preliminary would not only provide a complementary strategy for the detection of PMB, but also develop some new ideas for the construction of sensors for rapid antibiotic detection.
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Affiliation(s)
- Zhen Liu
- Beijing Laboratory of Food Quality and Safety, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Yijie Shi
- Department of Chemistry and Biology, Faculty of Environment and Life Science, Beijing University of Technology, Beijing 100124, China
| | - Chen Li
- Beijing Laboratory of Food Quality and Safety, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Wentong Hu
- Beijing Laboratory of Food Quality and Safety, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China
| | - Zhiyi Yao
- Beijing Laboratory of Food Quality and Safety, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing 100083, China.
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16
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Oweis AO, Zeyad HN, Alshelleh SA, Alzoubi KH. Acute Kidney Injury Among Patients with Multi-Drug Resistant Infection: A Study from Jordan. J Multidiscip Healthc 2022; 15:2759-2766. [PMID: 36504497 PMCID: PMC9733443 DOI: 10.2147/jmdh.s384386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Background Acute kidney injury (AKI) is a well-known complication for hospitalized patients. Sepsis and various infections play a significant role in increasing the incidence of AKI. The present study evaluated the risk for Multidrug-resistant (MDR) infections and its effect on the incidence of AKI, hospitalization, need for dialysis, and mortality. Methods In a retrospective study design, data were collected from all adult patients with a positive multi-drug resistant culture who were admitted to King Abdullah University Hospital (KAUH). Records of 436 patients were reviewed between January 2017 - December 2018 with at least one year of follow-up. Results The mean age was 57.3 years (SD± 23.1), and 58.5% were males. The most common source of positive cultures was sputum, with 50% positive cultures. The incidence of AKI was 59.2%. The most isolated microorganism was Acinetobacter baumannii (76.8%), followed by Pseudomonas aeruginosa (14.9%).On multivariate analysis, age (OR 1.1, 95% CI 1.1-1.2, P=0.001), HTN (OR 1.8, 95% CI 1.0-3.3, P=0.02), DM (OR 1.1, 95% CI 0.6-1.9, P=0.69) and the use of Foley catheter on chronic bases (OR 4.3, 95% CI 2.6-6.8, P<0.0001) were strong predictors of AKI. Among patients with AKI, 74.4% died compared to 44.4% among non-AKI patients (p<0.001). Conclusion In patients with MDR, AKI incidence, hospitalization, and mortality were high. Early detection and addressing the problem may decrease bad outcomes, and health education for reducing antibiotic abuse is needed to lower MDR.
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Affiliation(s)
- Ashraf O Oweis
- Department of Internal Medicine, Nephrology Division, Jordan University of Science and Technology, Irbid, Jordan,Correspondence: Ashraf O Oweis, Department of Internal Medicine, Nephrology division, Jordan University of Science and Technology, Irbid, Jordan, Tel +962791455505, Email
| | - Heba N Zeyad
- Department of Internal Medicine, Nephrology Division, Jordan University of Science and Technology, Irbid, Jordan
| | - Sameeha A Alshelleh
- Department of Internal Medicine, Nephrology Division, The University of Jordan, Amman, Jordan
| | - Karem H Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates,Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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17
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Wang JL, Xiang BX, Song XL, Que RM, Zuo XC, Xie YL. Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients: A meta-analysis. World J Clin Cases 2022; 10:11466-11485. [PMID: 36387815 PMCID: PMC9649555 DOI: 10.12998/wjcc.v10.i31.11466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/15/2022] [Accepted: 09/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Polymyxin-induced nephrotoxicity is a major safety concern in clinical practice due to long-term adverse outcomes and high mortality.
AIM To conducted a systematic review and meta-analysis of the prevalence and potential predictors of polymyxin-induced nephrotoxicity in adult intensive care unit (ICU) patients.
METHODS PubMed, EMBASE, the Cochrane Library and Reference Citation Analysis database were searched for relevant studies from inception through May 30, 2022. The pooled prevalence of polymyxin-induced nephrotoxicity and pooled risk ratios of associated factors were analysed using a random-effects or fixed-effects model by Stata SE ver. 12.1. Additionally, subgroup analyses and meta-regression were conducted to assess heterogeneity.
RESULTS A total of 89 studies involving 12234 critically ill adult patients were included in the meta-analysis. The overall pooled incidence of polymyxin-induced nephrotoxicity was 34.8%. The pooled prevalence of colistin-induced nephrotoxicity was not higher than that of polymyxin B (PMB)-induced nephrotoxicity. The subgroup analyses showed that nephrotoxicity was significantly associated with dosing interval, nephrotoxicity criteria, age, publication year, study quality and sample size, which were confirmed in the univariable meta-regression analysis. Nephrotoxicity was significantly increased when the total daily dose was divided into 2 doses but not 3 or 4 doses. Furthermore, older age, the presence of sepsis or septic shock, hypoalbuminemia, and concomitant vancomycin or vasopressor use were independent risk factors for polymyxin-induced nephrotoxicity, while an elevated baseline glomerular filtration rate was a protective factor against colistin-induced nephrotoxicity.
CONCLUSION Our findings indicated that the incidence of polymyxin-induced nephrotoxicity among ICU patients was high. It emphasizes the importance of additional efforts to manage ICU patients receiving polymyxins to decrease the risk of adverse outcomes.
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Affiliation(s)
- Jiang-Lin Wang
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Bi-Xiao Xiang
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Xiao-Li Song
- Department of Pharmacy, Sanya Central Hospital, Sanya 572000, Hainan Province, China
| | - Rui-Man Que
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Xiao-Cong Zuo
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
| | - Yue-Liang Xie
- Department of Pharmacy, The Third Xiangya Hospital of Central South University, Changsha 410013, Hunan Province, China
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18
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Yang J, Liu S, Lu J, Sun T, Wang P, Zhang X. An area under the concentration-time curve threshold as a predictor of efficacy and nephrotoxicity for individualizing polymyxin B dosing in patients with carbapenem-resistant gram-negative bacteria. Crit Care 2022; 26:320. [PMID: 36258197 PMCID: PMC9578216 DOI: 10.1186/s13054-022-04195-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evidence supports therapeutic drug monitoring of polymyxin B, but clinical data for establishing an area under the concentration-time curve across 24 h at steady state (AUCss,24 h) threshold are still limited. This study aimed to examine exposure-response/toxicity relationship for polymyxin B to establish an AUCss,24 h threshold in a real-world cohort of patients. METHODS Using a validated Bayesian approach to estimate AUCss,24 h from two samples, AUCss,24 h threshold that impacted the risk of polymyxin B-related nephrotoxicity and clinical response were derived by classification and regression tree (CART) analysis and validated by Cox regression analysis and logical regression analysis. RESULTS A total of 393 patients were included; acute kidney injury (AKI) was 29.0%, clinical response was 63.4%, and 30-day all-cause mortality was 35.4%. AUCss,24 h thresholds for AKI of > 99.4 mg h/L and clinical response of > 45.7 mg h/L were derived by CART analysis. Cox and logical regression analyses showed that AUCss,24 h of > 100 mg h/L was a significant predictor of AKI (HR 16.29, 95% CI 8.16-30.25, P < 0.001) and AUCss,24 h of ≥ 50 mg h/L (OR 4.39, 95% CI 2.56-7.47, P < 0.001) was independently associated with clinical response. However, these exposures were not associated with mortality. In addition, the correlation between trough concentration (1.2-2.8 mg/L) with outcomes was similar to AUCss,24 h. CONCLUSIONS For critically ill patients, AUCss,24 h threshold of 50-100 mg h/L was associated with decreased nephrotoxicity while assuring clinical efficacy. Therapeutic drug monitoring is recommended for individualizing polymyxin B dosing.
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Affiliation(s)
- Jing Yang
- grid.412633.10000 0004 1799 0733Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 45005 People’s Republic of China ,grid.207374.50000 0001 2189 3846Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China ,grid.207374.50000 0001 2189 3846Henan Engineering Research Center for Application and Translation of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Shaohua Liu
- grid.412633.10000 0004 1799 0733Department of General Intensive Care Unit, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Jingli Lu
- grid.412633.10000 0004 1799 0733Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 45005 People’s Republic of China ,grid.207374.50000 0001 2189 3846Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China ,grid.207374.50000 0001 2189 3846Henan Engineering Research Center for Application and Translation of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Tongwen Sun
- grid.412633.10000 0004 1799 0733Department of General Intensive Care Unit, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Peile Wang
- grid.412633.10000 0004 1799 0733Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 45005 People’s Republic of China ,grid.207374.50000 0001 2189 3846Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China ,grid.207374.50000 0001 2189 3846Henan Engineering Research Center for Application and Translation of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Xiaojian Zhang
- grid.412633.10000 0004 1799 0733Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zhengzhou, Henan 45005 People’s Republic of China ,grid.207374.50000 0001 2189 3846Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China ,grid.207374.50000 0001 2189 3846Henan Engineering Research Center for Application and Translation of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, People’s Republic of China
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Xu Y, Liang P, Liu N, Dong D, Gu Q, Wang X. Correlation between the drug concentration of polymyxin B and polymyxin B-associated acute kidney injury in critically ill patients: A prospective study. Pharmacol Res Perspect 2022; 10:e01010. [PMID: 36206131 PMCID: PMC9542723 DOI: 10.1002/prp2.1010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
In recent years, polymyxin B-associated acute kidney injury (PB-AKI) in critically ill patients has been reported frequently, but polymyxin B (PB) is mainly cleared through non-renal pathways, and the reasons of PB-AKI remain unclear. The aim of this study was to investigate the relationship between the serum concentration of PB and PB-AKI. We conducted a prospective cohort study in an intensive care unit between May 2019 and July 2021. Over the study period, 52 patients were included and divided into an AKI group (n = 26) and a non-AKI group (n = 26). The loading dose of PB in the AKI group was significantly higher than that in the non-AKI group. The C1/2 , Cmin , and estimated area under the concentration-time curve (AUC)0-24 of PB in the AKI group were dramatically increased compared with those in the non-AKI group, but the Cmax between the two groups showed no differences. Upon obtaining the ROC curve, the areas for the C1/2 , Cmin , and estimated AUC0-24 were 0.742, 0.710, and 0.710, respectively. The sensitivity was ascertained to be 61.54%, and the specificity was 76.92% when the cutoff value for the estimated AUC0-24 of 97.72 mg·h/L was used preferentially. The incidence of PB-AKI is high and related to the loading dose of PB. PB-AKI could be predicted when the estimated AUC0-24 of PB was greater than 97.72 mg·h/L.
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Affiliation(s)
- Ying Xu
- Surgical Intensive Care Unit (SICU), Department of General SurgeryJinling Hospital of Nanjing Medical UniversityNanjingChina,Intensive Care UnitDrum Tower Hospital Affiliated to Nanjing University School of MedicineNanjingJiangsuChina
| | - Pei Liang
- Department of PharmacyDrum Tower Hospital Affiliated to Nanjing University School of MedicineNanjingChina
| | - Ning Liu
- Intensive Care UnitDrum Tower Hospital Affiliated to Nanjing University School of MedicineNanjingJiangsuChina
| | - Danjiang Dong
- Intensive Care UnitDrum Tower Hospital Affiliated to Nanjing University School of MedicineNanjingJiangsuChina
| | - Qin Gu
- Intensive Care UnitDrum Tower Hospital Affiliated to Nanjing University School of MedicineNanjingJiangsuChina
| | - Xinying Wang
- Surgical Intensive Care Unit (SICU), Department of General SurgeryJinling Hospital of Nanjing Medical UniversityNanjingChina
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20
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Samarkos M, Papanikolaou K, Sourdi A, Paisios N, Mainas E, Paramythiotou E, Antoniadou A, Sambatakou H, Gargalianos-Kakolyris P, Skoutelis A, Daikos GL. The Effect of Different Colistin Dosing Regimens on Nephrotoxicity: A Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11081066. [PMID: 36009935 PMCID: PMC9405298 DOI: 10.3390/antibiotics11081066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: It is not known whether different daily dosing schemes have different effects on colistin nephrotoxicity. We examined the effect of once- versus twice- or thrice-daily doses of colistin on renal function. (2) Methods: We performed a multicenter retrospective cohort study of hospitalized patients with a baseline glomerular filtration rate ≥ 50 mL/min who received intravenously the same colistin dose once (regimen A), twice (regimen B) or thrice daily (regimen C). The primary endpoint was acute kidney injury (AKI), defined as fulfilment of any of the RIFLE (Risk-Injury-Failure-Loss-End stage renal disease) criteria. (3) Results: We included 306 patients; 132 (43.1%) received regimen A, 151 (49.3%) regimen B, and 23 (7.5%) regimen C. Ninety-nine (32.4%) patients developed AKI; there was no difference between regimen A vs. B and C [45 (34.1%) vs. 54 (31.0%), p = 0.57]. In a propensity score−matched cohort, AKI was similar in patients receiving Regimen A, Regimen B, and Regimen C (31.6% vs. 33.3%, p = 0.78). On logistic regression analysis, diabetes was an independent predictor of AKI (OR = 4.59, 95% CI 2.03−10.39, p = 0.001) while eGFR > 80 mL/min (OR = 0.50, 95% CI 0.25−0.99, p = 0.048) was inversely associated with AKI. (4) Conclusions: Colistin once daily is not more nephrotoxic than the standard colistin regimens. The only independent predictor of nephrotoxicity was diabetes mellitus, while eGFR > 80 mL/min had a protective effect.
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Affiliation(s)
- Michael Samarkos
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Athena Sourdi
- 1st Propaedeutic Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Nikolaos Paisios
- 1st Department of Medicine, G. Gennimatas General Hospital, 11527 Athens, Greece
| | - Efstratios Mainas
- 2nd Department of Medicine, Ippokrateion General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Anastasia Antoniadou
- 4th Department of Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Helen Sambatakou
- 2nd Department of Medicine, Ippokrateion General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | | | - George L. Daikos
- 1st Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence:
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21
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Wang PL, Liu P, Zhang QW, Yuan WH, Wang D, Zhang XJ, Yang J. Population pharmacokinetics and clinical outcomes of polymyxin B in paediatric patients with multidrug-resistant Gram-negative bacterial infections. J Antimicrob Chemother 2022; 77:3000-3008. [PMID: 35924405 DOI: 10.1093/jac/dkac265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/15/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Current polymyxin B dosing in children relies on scant data. OBJECTIVES To build a population pharmacokinetic (PK) model for polymyxin B in paediatric patients and assess the likely appropriateness of different dosages. METHODS A total of 19 paediatric patients were enrolled to receive intravenous polymyxin B (1.33-2.53 mg/kg/day), and the median age was 12.5 (range 3.2-17.8) years. Serial plasma samples were collected at steady-state and modelled by population PK analysis. Clinical efficacy and nephrotoxicity of polymyxin B treatment were also assessed. RESULTS PK data were adequately described by a two-compartment model with first-order elimination, and weight was a significant covariate of polymyxin B clearance. Clinical success occurred in 14 of 19 patients (73.7%) and only one patient developed acute kidney injury. The 28 day mortality was 10.5% (2/19). The steady-state polymyxin B exposure was 36.97 ± 9.84 mg·h/L, lower than the therapeutic exposure of 50-100 mg·h/L. With the AUC24h/MIC target of 50, the dosage of 1.5-3.0 mg/kg/day had a probability of target attainments over 90% when MICs were <0.5 mg/L. CONCLUSIONS Dose adjustment of polymyxin B needs to consider the MIC of infecting pathogens. Current polymyxin B dosing for paediatric patients may be acceptable when MICs are <0.5 mg/L.
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Affiliation(s)
- Pei Le Wang
- Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Peng Liu
- Department of Pediatric Intensive Care Unit, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Wen Zhang
- Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Wen Hua Yuan
- Department of Pediatric Intensive Care Unit, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dao Wang
- Department of Pediatrics, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Jian Zhang
- Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Jing Yang
- Department of Pharmacy, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
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22
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Deng Y, Gu JY, Li X, Tong H, Guo SW, Xu B, Li Y, Zhang BK, Li Y, Huang HY, Xiao GY. Does Monitoring Total and Free Polymyxin B1 Plasma Concentrations Predict Polymyxin B-Induced Nephrotoxicity? A Retrospective Study in Critically Ill Patients. Infect Dis Ther 2022; 11:1591-608. [PMID: 35689791 DOI: 10.1007/s40121-022-00655-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The correlation between total and free polymyxin B (PMB including PMB1 and PMB2) exposure in vivo and acute kidney injury (AKI) remains obscure. This study explores the relationships between plasma exposure of PMB1 and PMB2 and nephrotoxicity, and investigates the risk factors for PMB-induced acute kidney injury (AKI) in critically ill patients. METHODS Critically ill patients who used PMB and met the criteria were enrolled. The total plasma concentration and plasma binding of PMB1 and PMB2 were analysed by liquid chromatography-tandem mass spectrometry and equilibrium dialysis. RESULTS A total of 89 patients were finally included, and AKI developed in 28.1% of them. The peak concentration of PMB1 (Cmax (B1)) (adjusted odds ratio (AOR) = 1.68, 95% CI 1.08-2.62, p = 0.023), baseline BUN level (AOR = 1.08, 95% CI 1.01-1.16, p = 0.039) and hypertension (AOR = 3.73, 95% CI 1.21-11.54, p = 0.022) were independent risk factors for PMB-induced AKI. The area under the ROC curve of the model was 0.799. When Cmax (B1) was 5.23 μg/ml or more, the probability of AKI was higher than 50%. The ratio of PMB1/PMB2 decreased after PMB preparation entered into the body. The protein binding rate in critically ill patients indicated significant individual differences. Free Cmax (B) and free Cmax (B1) levels in the AKI group were significantly (p < 0.05) higher than those in the non-AKI group. Total and free concentrations of PMB in patients showed a positive correlation. CONCLUSIONS Both the ROC curve and logistic regression model showed that Cmax (B1) was a good predictor for the probability of PMB-induced AKI. Early therapeutic drug monitoring (TDM) of PMB should be considered in critically ill patients. Compared with Cmin (B), Cmax (B) and Cmax (B1) may be helpful for the early prediction of PMB-induced AKI in critically ill patients.
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Shahbazi F, Shojaei L, Farvadi F, Kadivarian S. Antimicrobial safety considerations in critically ill patients: part I: focused on acute kidney injury. Expert Rev Clin Pharmacol 2022; 15:551-561. [PMID: 35734940 DOI: 10.1080/17512433.2022.2093713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Antibiotic prescription is a challenging issue in critical care settings. Different pharmacokinetic and pharmacodynamic properties, polypharmacy, drug interactions, and high incidence of multidrug-resistant microorganisms in this population can influence the selection, safety, and efficacy of prescribed antibiotics. AREAS COVERED In the current article, we searched PubMed, Scopus, and Google Scholar for estimating renal function in acute kidney injury, nephrotoxicity of commonly used antibiotics, and nephrotoxin stewardship in intensive care units. EXPERT OPINION Early estimation of kidney function with an accurate method may be helpful to optimize antimicrobial treatment in critically ill patients. Different antibiotic dosing regimens may be required for patients with acute kidney injury. In many low-resource settings, therapeutic drug monitoring is not available for antibiotics. Acute kidney injury may influence treatment effectiveness and patient outcome.
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Affiliation(s)
- Foroud Shahbazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Lida Shojaei
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fakhrossadat Farvadi
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Kadivarian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Jia X, Yin Z, Zhang W, Guo C, Du S, Zhang X. Effectiveness and Nephrotoxicity of Intravenous Polymyxin B in Carbapenem-Resistant Gram-Negative Bacterial Infections Among Chinese Children. Front Pharmacol 2022; 13:902054. [PMID: 35712713 PMCID: PMC9197179 DOI: 10.3389/fphar.2022.902054] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: No clinical study on the use of polymyxin B in Chinese children has been reported, thus making it difficult for pediatric clinicians to rationally select these drugs. Methods: A retrospective analysis of children treated with polymyxin B during hospitalization in a hospital from June 2019 to June 2021 was conducted to analyze its effectiveness and the incidence of acute kidney injury (AKI) during treatment with polymyxin B. Results: A total of 55 children were included in this study, and the results showed that the intravenous polymyxin B-based regimen had an effective rate of 52.7% in the treatment of Carbapenem-resistant Gram-negative bacterial (CR-GNB) infection in children. The results of the subgroup analysis showed that the course of treatment was longer in the favorable clinical response group than in the unfavorable outcome group (p = 0.027) and that electrolyte disturbances in children during the course of treatment could lead to unfavorable clinical outcomes (p = 0.042). The risk of incidence of AKI during treatment was 27.3%, and the all-cause mortality rate in the children on their discharge from the hospital was 7.3%. Conclusion: Polymyxin B can be used as a salvage therapy for CR-GNB infection in children when no other susceptible antibiotics are available, and the monitoring of kidney function should be strengthened.
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Affiliation(s)
- Xuedong Jia
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- The Precision Clinical Pharmacy Key Laboratory of Henan, Zhengzhou, China
- *Correspondence: Xuedong Jia, ; Shuzhang Du,
| | - Zhao Yin
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- The Precision Clinical Pharmacy Key Laboratory of Henan, Zhengzhou, China
| | - Wan Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- The Precision Clinical Pharmacy Key Laboratory of Henan, Zhengzhou, China
| | - Conghui Guo
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuzhang Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- The Precision Clinical Pharmacy Key Laboratory of Henan, Zhengzhou, China
- *Correspondence: Xuedong Jia, ; Shuzhang Du,
| | - Xiaojian Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- The Precision Clinical Pharmacy Key Laboratory of Henan, Zhengzhou, China
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Ye Q, Wang Q, Chen Z, Chen W, Zhan Q, Wang C. Effectiveness, nephrotoxicity, and therapeutic drug monitoring of polymyxin B in nosocomial pneumonia among critically ill patients. Clin Respir J 2022; 16:402-412. [PMID: 35586931 PMCID: PMC9366561 DOI: 10.1111/crj.13493] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We aimed to assess the effectiveness and nephrotoxicity of polymyxin B in critically ill patients with nosocomial pneumonia and to evaluate the utility of its therapeutic drug monitoring (TDM). METHODS We retrospectively analyzed patients who received polymyxin B treatment for ≥48 h since the establishment of polymyxin B TDM in a 26-bed tertiary referral intensive care unit. Univariate and multivariate analyses were conducted to assess the variables associated with polymyxin B effectiveness and nephrotoxicity. RESULTS A total of 62 patients were enrolled. Most (56.5%) of the patients performed TDM, 54.3% of them reached the therapeutic target of area under curve across 24 h at steady state (AUCss,24h ) of 50-100 mg h L-1 , and 10 patients had an AUCss,24h value of <50 mg h L-1 . Thirty-six (58.1) and 31 (50.0%) patients had favorable clinical and microbiological responses, respectively. Reaching the therapeutic target of AUCss,24h (odds ratio [OR] = 13.15, p = 0.015), a favorable microbiological response (OR = 40.80, p = 0.00), and complicated with septic shock (OR = 0.12, p = 0.021) were independently associated with favorable clinical outcomes of polymyxin B treatment. The incidence of acute kidney injury (AKI) was 45.2%. A lower creatinine clearance (OR = 0.96, p = 0.008) and concomitant treatment with loop diuretics (OR = 5.93, p = 0.046) were predictive of nephrotoxicity. CONCLUSION Our findings show that TDM of polymyxin B is a valuable intervention, and the achievement of its optimal pharmacodynamic target can improve treatment outcome. Renal insufficiency and concomitant treatment with loop diuretics were found to be associated with the risk of nephrotoxicity.
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Affiliation(s)
- Qinghua Ye
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Qianlin Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ziying Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Wenqian Chen
- Department of Pharmacy, China-Japan Friendship Hospital, Beijing, China
| | - Qingyuan Zhan
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Chen Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China.,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Wu XL, Long WM, Lu Q, Teng XQ, Qi TT, Qu Q, He GF, Qu J. Polymyxin B-Associated Nephrotoxicity and Its Predictors: A Retrospective Study in Carbapenem-Resistant Gram-Negative Bacterial Infections. Front Pharmacol 2022; 13:672543. [PMID: 35571125 PMCID: PMC9096016 DOI: 10.3389/fphar.2022.672543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Polymyxin B (PMB), a kind of polymyxin, was widely used in carbapenem-resistant Gram-negative bacterial (CR-GNB) infections. However, adverse reactions such as nephrotoxicity and neurotoxicity limit its use in clinical practice. The aim of this study was to explore PMB associated with nephrotoxicity and its predictors. Patients who received PMB intravenous drip for more than 72 h were eligible for the study. Characteristics of patients, concomitant nephrotoxic agents, underlying disease, and antimicrobial susceptibility were submitted for descriptive analysis. Univariate analysis and binary logistic regression were used to assess the factors leading to acute kidney injury (AKI). AKI was assessed with serum creatinine variations according to the classification of risk (stage R), injury (stage I), failure (stage F), loss, and end-stage of kidney disease. Among 234 patients with CR-GNB infections who used PMB in our study, 67 (28.63%) patients developed AKI, including 31 (14.25%) patients in stage R, 15 (6.41%) patients in stage I, and 21 (8.97%) patients in stage F. The incident rate of PMB-related nephrotoxicity in patients with normal renal function was 32.82% (43/131). The higher risk factors of AKI include males [odds ratio (OR) = 3.237; 95% confidence interval (95%CI) = 1.426–7.350], digestive system diseases [OR = 2.481 (1.127–5.463)], using furosemide (>20 mg/day) [OR = 2.473 (1.102–5.551)], and baseline serum creatinine [OR = 0.994 (0.990–0.999)]. Nonparametric tests of K-independent samples showed that baseline serum creatinine and the PMB maintenance dose were associated with the severity of nephrotoxicity (both p < 0.05). Male, digestive system diseases, using furosemide (>20 mg/day), and high baseline serum creatinine were the independent risk factors of PMB-associated AKI development. The maintenance dose of PMB may be related to the severity of AKI. These risk factors should be taken into consideration when initiating PMB-based therapy. The serum creatinine value should be closely monitored when using PMB.
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Affiliation(s)
- Xiao-Li Wu
- Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China
- Department of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen-Ming Long
- Department of Pharmacy, Second People’s Hospital of Huaihua City, Huaihua, China
| | - Qiong Lu
- Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Xin-Qi Teng
- Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ting-Ting Qi
- Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Ge-Fei He
- Department of Pharmacy, The First Hospital of Changsha, Changsha, China
| | - Jian Qu
- Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China
- *Correspondence: Jian Qu,
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Jia X, Guo C, Yin Z, Zhang W, Du S, Zhang X. Risk Factors for Acute Kidney Injury Induced by Intravenous Polymyxin B in Chinese Patients with Severe Infection. Infect Drug Resist 2022; 15:1957-1965. [PMID: 35469305 PMCID: PMC9034847 DOI: 10.2147/idr.s363944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Xuedong Jia
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
- The Precision Clinical Pharmacy Key Laboratory of Henan Province, Zhengzhou, People’s Republic of China
- Correspondence: Xuedong Jia; Shuzhang Du, Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China, Email ;
| | - Cuohui Guo
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Zhao Yin
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
- The Precision Clinical Pharmacy Key Laboratory of Henan Province, Zhengzhou, People’s Republic of China
| | - Wan Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
- The Precision Clinical Pharmacy Key Laboratory of Henan Province, Zhengzhou, People’s Republic of China
| | - Shuzhang Du
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
- The Precision Clinical Pharmacy Key Laboratory of Henan Province, Zhengzhou, People’s Republic of China
| | - Xiaojian Zhang
- Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China
- The Precision Clinical Pharmacy Key Laboratory of Henan Province, Zhengzhou, People’s Republic of China
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OUP accepted manuscript. J Antimicrob Chemother. [DOI: 10.1093/jac/dkac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/13/2022] [Indexed: 11/14/2022] Open
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29
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Wen YX, Qu Q, Long WM, Luo Y, Zhuang HH, Teng XQ, Qu J. Nephrotoxicity and Efficacy Assessment of Polymyxin B Use in Renal Transplant Patients. Infect Drug Resist 2022; 15:275-283. [PMID: 35115795 PMCID: PMC8801393 DOI: 10.2147/idr.s348571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yu-Xin Wen
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha, 410011, People’s Republic of China
- Department of Pharmacy, Lixian People’s Hospital in Hunan, Lixian, 415500, People’s Republic of China
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, 410078, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, People’s Republic of China
| | - Wen-Ming Long
- Department of Pharmacy, Jingzhou District, Second People’s Hospital of Huaihua City, Huaihua, 418400, People’s Republic of China
| | - Yue Luo
- Department of Pharmacy, The People’s Hospital of Liuyang, Liuyang, 410300, People’s Republic of China
| | - Hai-Hui Zhuang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha, 410011, People’s Republic of China
| | - Xin-Qi Teng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha, 410011, People’s Republic of China
| | - Jian Qu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, Changsha, 410011, People’s Republic of China
- Correspondence: Jian Qu, Department of Pharmacy, The Second Xiangya Hospital, Central South University; Institute of Clinical Pharmacy, Central South University, No. 139 Middle Renmin Road, Changsha, 410011, People’s Republic of China, Tel +86-15973190614, Fax +86-731-85292072, Email
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Stern A, Alonso CD, Garcia-Vidal C, Cardozo C, Slavin M, Yong MK, Ho SA, Mehta Steinke S, Avery RK, Koehler P, Scheid C, Cornely OA, Maertens J, Abi Aad Y, Epstein DJ, Papanicolaou GA, Neofytos D. Safety and efficacy of intravenously administered cidofovir in adult haematopoietic cell transplant recipients: a retrospective multicentre cohort study. J Antimicrob Chemother 2021; 76:3020-3028. [PMID: 34324678 DOI: 10.1093/jac/dkab259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/25/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of cidofovir for the treatment of double-stranded DNA (dsDNA) viral infections following allogeneic haematopoietic cell transplant (HCT). METHODS This was a retrospective multicentre cohort study including adult HCT recipients who received ≥1 dose of IV-administered cidofovir for any dsDNA viral infection from 2006 to 2019. The objectives were to describe the rate of and risk factors for nephrotoxicity and virological response by the end of treatment (EOT). RESULTS We included 165 patients from nine centres. Cidofovir was administered at 5 mg/kg/week (N = 115; 69.7%), 1 mg/kg/week (18; 10.9%), 3 mg/kg/week (12; 7.3%) or 1 mg/kg three times/week (11; 6.7%). Cidofovir was administered for adenovirus, cytomegalovirus (CMV) and BK virus infection in 75 (45.5%), 64 (38.8%) and 51 (30.9%) patients, respectively. Among 158 patients with renal function data at baseline and EOT, 40 (25.3%) developed nephrotoxicity. In multivariable analyses, age (OR 1.04; P = 0.05), weight (OR 1.05; P = 0.01), CMV infection (OR 3.6; P = 0.02), liposomal amphotericin B (OR 8.06; P = 0.05) and IV voriconazole/posaconazole (OR 13.0; P = 0.003) were predictors of nephrotoxicity. Creatinine concentration was significantly higher at EOT (1.16 ± 0.95 mg/dL) compared with baseline (0.91 ± 0.39 mg/dL; P < 0.001), but improved by 2 weeks (0.91 ± 0.84 mg/dL; P = 0.007) and 4 weeks (0.96 ± 0.89 mg/dL; P = 0.03) post-EOT. Median viral load significantly declined for patients with adenovirus DNAaemia by EOT (P < 0.0001) and for patients with CMV DNAaemia by EOT + 4 weeks (P = 0.003), but not for patients with BK virus DNAaemia. CONCLUSIONS One in four HCT recipients treated with IV cidofovir developed largely reversible nephrotoxicity. Careful selection of patients and close follow-up of renal function may minimize toxicity.
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Affiliation(s)
- Anat Stern
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel
| | - Carolyn D Alonso
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, USA
| | | | - Celia Cardozo
- Division of Infectious Diseases, Hospital Clinic, Barcelona, Spain
| | - Monica Slavin
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michelle K Yong
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Su Ann Ho
- Department of Infectious Disease and the National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Seema Mehta Steinke
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Robin K Avery
- Division of Infectious Diseases, Johns Hopkins University, School of Medicine, Baltimore, USA
| | - Philipp Koehler
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Christof Scheid
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Faculty of Medicine and University Hospital Cologne, Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | | | - Yasmine Abi Aad
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
| | - David J Epstein
- Division of Infectious Diseases, Stanford University, Stanford, CA, USA
| | | | - Dionysios Neofytos
- Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland
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Pickkers P, Darmon M, Hoste E, Joannidis M, Legrand M, Ostermann M, Prowle JR, Schneider A, Schetz M. Acute kidney injury in the critically ill: an updated review on pathophysiology and management. Intensive Care Med 2021; 47:835-50. [PMID: 34213593 DOI: 10.1007/s00134-021-06454-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/04/2021] [Indexed: 01/10/2023]
Abstract
Acute kidney injury (AKI) is now recognized as a heterogeneous syndrome that not only affects acute morbidity and mortality, but also a patient’s long-term prognosis. In this narrative review, an update on various aspects of AKI in critically ill patients will be provided. Focus will be on prediction and early detection of AKI (e.g., the role of biomarkers to identify high-risk patients and the use of machine learning to predict AKI), aspects of pathophysiology and progress in the recognition of different phenotypes of AKI, as well as an update on nephrotoxicity and organ cross-talk. In addition, prevention of AKI (focusing on fluid management, kidney perfusion pressure, and the choice of vasopressor) and supportive treatment of AKI is discussed. Finally, post-AKI risk of long-term sequelae including incident or progression of chronic kidney disease, cardiovascular events and mortality, will be addressed.
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Lu Q, Zhu HH, Li GH, Qi TT, Ye LJ, Teng XQ, Qu Q, He GF, Qu J. A Comparative Study of the Microbiological Efficacy of Polymyxin B on Different Carbapenem-Resistant Gram-Negative Bacteria Infections. Front Med (Lausanne) 2021; 8:620885. [PMID: 33634151 PMCID: PMC7902010 DOI: 10.3389/fmed.2021.620885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/15/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: The emergence of carbapenem-resistant gram-negative bacteria (CR-GNB) has brought great challenges to clinical anti-infection treatment around the world. Polymyxins are often considered as the last line of defense in the treatment of CR-GNB infections. In this study, we explored the microbiological efficacy of Polymyxin B (PMB) on different CR-GNB infections as well as the factors influencing microbiological efficacy. Methods: CR-GNB infected patients with PMB-based regimens were enrolled. Clinical and microbiological data were collected from the medical electronic record system of the Second Xiangya hospital. The efficacy of PMB on different CR-GNB was evaluated by the clearance rate at 7-days and within the course of treatment, as well as the 30-day mortality rate. Results: A total of 294 CR-GNB infected patients were enrolled: 154 CR-Acinetobacter baumannii (CRAB), 55 CR-Klebsiella pneumoniae (CRKP), and 85 CR-Pseudomonas aeruginosa (CRPA). The CRAB group had the highest 7-day bacterial clearance rate [(CRAB: 39.0%) vs. (CRKP: 29.4%) vs. (CRPA: 14.5%), P = 0.003] and total bacterial clearance rate [(CRAB: 49.0%) vs. (CRKP: 39.8%) vs. (CRPA: 18.2%), P < 0.001] among the three groups, while the bacterial clearance rate of the CRPA group was the lowest. Multivariate logistic regression showed that the differences among the three groups were multiple CR-GNB infections (P = 0.004), respiratory infections (P = 0.001), PMB resistance (P < 0.001), and the combination of tigecycline (P < 0.001). Binary logistic regression showed that multiple CR-GNB infection [(7-day bacterial clearance: P = 0.004) & (total bacterial clearance: P = 0.011)] and bacterial species [(7-day bacterial clearance: P < 0.001) & (total bacterial clearance: P < 0.001)] were independent risk factors for microbiological efficacy. Conclusion: PMB exhibited differential microbiological efficacy on different types of CR-GNB infections; it had the best effect on CRAB, followed by CRKP and CRPA. Multiple CR-GNB infections and bacterial species were independent risk factors for microbiological efficacy.
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Affiliation(s)
- Qiong Lu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Hai-Hong Zhu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Guo-Hua Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Ting-Ting Qi
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Liang-Jun Ye
- Department of Pharmacy, Hunan Provincial Corps Hospital of Chinese People's Armed Police Force, Changsha, China
| | - Xin-Qi Teng
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Qiang Qu
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
| | - Ge-Fei He
- Department of Pharmacy, The First Hospital of Changsha, Changsha, China
| | - Jian Qu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Institute of Clinical Pharmacy, Central South University, Changsha, China
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