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Polymyxin B for Gram Negative Multidrug Resistant Bacteria in a Hispanic Population

Rafael De León-Borrás1, Carlos Sánchez-Sergentón1, Angel Mayor-Becerra2

  • 1Division of Infectious Diseases, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.

Puerto Rico Health Sciences Journal
|March 30, 2019
PubMed
Abstract

Insights

Multidrug-resistant (MDR) infections in the ICU, particularly by A. baumannii, K. pneumoniae, and P. aeruginosa, are associated with high mortality. Polymyxin B treatment showed a reduction in ICU mortality, especially when combined with daptomycin.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Pharmacology

Background:

  • Multidrug-resistant (MDR) bacterial infections pose a significant threat in intensive care units (ICUs).
  • Key pathogens include Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa.
  • Limited treatment options exist for MDR infections, necessitating research into effective therapies.

Purpose of the Study:

  • To determine the prevalence of MDR infections by A. baumannii, K. pneumoniae, and P. aeruginosa in a tertiary care teaching hospital ICU.
  • To estimate the mortality rate associated with these infections.
  • To compare morbidity and mortality differences between patients treated with and without polymyxin B.

Main Methods:

  • Retrospective study of adult patients admitted to the ICU with positive cultures from January 2012 to June 2013.
  • Analysis of patient demographics, treatment regimens, and outcomes.
  • Comparison of mortality rates and survival factors between treatment groups.

Main Results:

  • High mortality rates were observed for single MDR bacterial infections: 88% for A. baumannii, 84% for K. pneumoniae, and 67% for P. aeruginosa.
  • All patients with multiple MDR infections died in the ICU.
  • Polymyxin B use was associated with higher survival, as was daptomycin. Vancomycin and vasopressors were linked to worse outcomes. Polymyxin B nephrotoxicity occurred in 15% of patients.

Conclusions:

  • Polymyxin B treatment was associated with a reduction in ICU mortality.
  • A combination of polymyxin B and daptomycin showed improved survival, warranting further investigation.
  • Effective management of MDR infections in ICUs remains a critical challenge.
Keywords:
HispanicMDRPolymyxin B

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