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Clinical features and mortality of patients on renal replacement therapy receiving polymyxin B

Maria Helena Rigatto1, Diego R Falci2, Natane T Lopes3

  • 1Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St., Porto Alegre 90.035-903, Brazil.

International Journal of Antimicrobial Agents
|January 9, 2016
PubMed

Insights

Polymyxin B (PMB) dosing in renal replacement therapy (RRT) patients is unclear. Higher daily PMB doses (≥200mg) were linked to reduced 30-day mortality in this RRT patient cohort.

Area of Science:

  • Nephrology
  • Infectious Diseases
  • Clinical Pharmacology

Background:

  • Limited clinical data exists for polymyxin B (PMB) use in patients undergoing renal replacement therapy (RRT).
  • Optimal PMB dosing strategies in RRT patients remain undefined, impacting treatment efficacy and patient outcomes.

Purpose of the Study:

  • To characterize patients on RRT receiving PMB.
  • To identify predictors of 30-day mortality in this population, with a focus on PMB dosage.

Main Methods:

  • A multicenter prospective cohort study involving 88 adult patients on RRT receiving PMB for at least 48 hours.
  • Data collected included RRT modality (continuous venovenous haemodialysis or intermittent haemodialysis), PMB dosage, comorbidities (Charlson index), and severity scores (APACHE II).
  • Statistical analysis identified predictors of 30-day mortality.

Main Results:

  • The 30-day mortality rate was 51.1%.
  • While the dose in mg/kg was not associated with mortality, a higher average daily PMB dose (≥200mg) predicted decreased 30-day mortality (HR=0.35).
  • Independent risk factors for mortality included continuous venovenous haemodialysis, higher Charlson and APACHE II scores, and Pseudomonas aeruginosa infection.

Conclusions:

  • This is the first clinical study to suggest that higher daily doses of polymyxin B may be associated with lower 30-day mortality in patients on renal replacement therapy.
  • Further research is warranted to establish definitive dosing guidelines for PMB in RRT patients to optimize survival outcomes.
Keywords:
DoseHaemodialysisMortalityPolymyxin B

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