Colistin Sulfate-Based Combination Therapy for Infections Caused by Carbapenem-Resistant Organisms in Intensive Care Units: A Multicenter, Prospective, Observational Clinical Trial.

IF 5.3 3区医学 Q1 INFECTIOUS DISEASES

Infectious Diseases and Therapy Pub Date : 2025-06-29 DOI:10.1007/s40121-025-01176-5

Fan Zhang, Danyang Peng, Faming He, Ying Liu, Binbin Zang, Yanqiu Gao, Chao Qin, Suping Guo, Yawei Qi, Xisheng Zheng, Lin Guo, Tingting Zhao, Yue Jin, Rongqi Su, Juan Du, Jiazhan Pan, Bingyu Qin, Huanzhang Shao

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引用次数: 0

Abstract

Introduction: With the rapid spread of carbapenem-resistant Gram-negative bacterial infections, polymyxins have reemerged as a critical "salvage" antibiotic option.

Methods: This multicenter observational study assessed the effectiveness and safety of colistin sulfate-based treatment for carbapenem-resistant organism (CRO) infections in patients in intensive care across ten clinical sites in China. Clinical and microbiological responses, 28-day all-cause mortality, and associated risk factors were analyzed. Nephrotoxicity was assessed using Kidney Disease Improving Global Outcomes (KDIGO) criteria.

Results: Of 240 critically ill adult patients with confirmed CRO infection, 91.3% had pulmonary infection, and 77.1% and 52.5% achieved clinical and microbiological response, respectively. Subgroup analyses showed associations between outcomes and patient age and colistin sulfate treatment duration. The 28-day all-cause mortality was 27.1%. Clinical response and mortality were significantly associated with Sequential Organ Failure Assessment (SOFA) score and colistin sulfate treatment duration. Analysis of the receiver operating characteristic (ROC) curve revealed that the thresholds for colistin treatment duration for predicting clinical response and survival were > 9.5 days (area under the curve [AUC] > 0.7). Nephrotoxicity was reported in 13.1% of patients not receiving continuous renal replacement therapy (CRRT), with no significant duration-dependent increase. Post-treatment serum creatinine (Scr) levels remained stable or improved across all renal function subgroups.

Conclusions: Colistin sulfate in combination with other antimicrobials can be considered a reasonable and safe treatment option for CRO infections. Understanding the factors involved in this potential beneficial treatment can enable more careful follow-up of patients.

Trial registration: ChiCTR, ChiCTR2100044866. Registered on 30 March 2021, https://www.chictr.org.cn/showproj.html?proj=124119 .

查看原文本刊更多论文

以硫酸粘菌素为基础的联合治疗重症监护病房碳青霉烯耐药菌感染：一项多中心、前瞻性、观察性临床试验。

随着碳青霉烯耐药革兰氏阴性细菌感染的迅速传播，多粘菌素已重新成为一种关键的“救救性”抗生素选择。方法：本多中心观察性研究评估了中国10个临床站点重症监护患者中以硫酸粘菌素为基础治疗碳青霉烯耐药菌（CRO）感染的有效性和安全性。分析临床和微生物反应、28天全因死亡率和相关危险因素。采用肾病改善全球预后（KDIGO）标准评估肾毒性。结果：240例确诊CRO感染的危重成人患者中，91.3%发生肺部感染，77.1%达到临床应答，52.5%达到微生物应答。亚组分析显示结果与患者年龄和硫酸粘菌素治疗时间有关。28天全因死亡率为27.1%。临床反应和死亡率与序贯器官衰竭评估（SOFA）评分和硫酸粘菌素治疗时间显著相关。受试者工作特征（ROC）曲线分析显示，粘菌素治疗时间预测临床反应和生存的阈值为> 9.5天（曲线下面积[AUC] > 0.7）。未接受持续肾替代治疗（CRRT）的患者中有13.1%报告肾毒性，无明显的持续时间依赖性增加。治疗后血清肌酐（Scr）水平在所有肾功能亚组中保持稳定或改善。结论：硫酸粘菌素联合其他抗菌素可被认为是治疗CRO感染的一种合理、安全的选择。了解这种潜在的有益治疗所涉及的因素可以使患者更仔细地随访。试验注册：ChiCTR， ChiCTR2100044866。于2021年3月30日注册，网址：https://www.chictr.org.cn/showproj.html?proj=124119。

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来源期刊

Infectious Diseases and Therapy Medicine-Microbiology (medical)

CiteScore

8.60

自引率

1.90%

发文量

136

审稿时长

6 weeks

期刊介绍： Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.