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Nephrotoxicity and efficacy assessment of polymyxin use in 92 transplant patients
Marcelo M Mostardeiro1, Carlos A P Pereira, Alexandre R Marra
1Solid Organ Transplant Infectious Disease Unit, Infectious Disease Division, Federal University of São Paulo, São Paulo, Brazil. mm.mostardeiro@gmail.com
Abstract:
Polymyxins are old antimicrobials, discontinued for many years because of nephrotoxicity and neurotoxicity reports and reintroduced recently due to the increasing frequency of multiresistant Gram-negative bacterial infections. There are very few data related to toxicity and efficacy from transplanted patients, the major subjects of this study. All solid-organ-transplanted patients from our institution during January 2001 to December 2007 who used polymyxins were retrospectively assessed for nephrotoxicity and treatment efficacy. Microbiological and clinical cure rates were 100% and 77.2%, respectively. Only transplant patients subjected to at least 72 h of intravenous polymyxin were entered in the study. Overall, 92 transplant patients were included, and the nephrotoxicity rate was 32.6%. Multivariate analysis showed a statistically significant association between duration of polymyxin treatment (P = 0.037; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.00 to 1.12) and significant renal dysfunction. Polymyxin use is associated with very high rates of significant decrease in renal function; therefore, polymyxin must be used only when no other option is available and for as briefly as possible in the solid organ transplant setting.
Insights
Polymyxins are effective against multidrug-resistant Gram-negative infections in transplant patients, but prolonged use significantly increases the risk of kidney damage. Shorter treatment durations are recommended for these vulnerable patients.
Area of Science:
- Infectious Diseases
- Nephrology
- Transplantation Medicine
Background:
- Polymyxins, once discontinued due to toxicity, are now vital for treating multidrug-resistant Gram-negative bacterial infections.
- Data on polymyxin efficacy and toxicity in solid-organ transplant recipients are scarce.
- Multidrug-resistant infections pose a significant challenge in immunocompromised populations like transplant patients.
Purpose of the Study:
- To evaluate the nephrotoxicity and treatment efficacy of polymyxins in solid-organ transplant patients.
- To identify risk factors associated with polymyxin-induced renal dysfunction in this specific patient group.
Main Methods:
- Retrospective assessment of 92 solid-organ transplant patients treated with polymyxins between January 2001 and December 2007.
- Analysis of microbiological and clinical cure rates.
- Multivariate analysis to determine associations between treatment duration and renal dysfunction.
Main Results:
- High rates of microbiological (100%) and clinical (77.2%) cure were observed.
- A significant nephrotoxicity rate of 32.6% was recorded.
- Increased duration of intravenous polymyxin treatment (≥72 hours) was significantly associated with renal dysfunction (OR, 1.06; P = 0.037).
Conclusions:
- Polymyxin use in solid-organ transplant patients is linked to substantial rates of decreased renal function.
- Polymyxins should be reserved for situations with no alternative treatments and administered for the shortest possible duration in transplant recipients.
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