Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective study
BackgroundPolymyxin B sulfate (PBS) and colistin sulfate (CS) are the last-line treatments for infections caused by multidrug-resistant Gram-negative bacteria, but their efficacy and safety have not been validated. The aims of the current study were to (1) determine their efficacy and safety among c...
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Frontiers Media S.A.
2025-01-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2024.1466888/full |
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| author | Yijing Zhang Chuhui Wang Jiaojiao Chen Chuqi Bai Dan Sun Yulan Qiu Mengmeng Teng Yalin Dong |
| author_facet | Yijing Zhang Chuhui Wang Jiaojiao Chen Chuqi Bai Dan Sun Yulan Qiu Mengmeng Teng Yalin Dong |
| author_sort | Yijing Zhang |
| collection | DOAJ |
| description | BackgroundPolymyxin B sulfate (PBS) and colistin sulfate (CS) are the last-line treatments for infections caused by multidrug-resistant Gram-negative bacteria, but their efficacy and safety have not been validated. The aims of the current study were to (1) determine their efficacy and safety among critically ill patients and the influencing factors, and (2) determine the relationships of drug exposure with efficacy and safety, to provide evidence for the precision dosing.MethodThis retrospective study included 100 critically ill patients treated with PBS and 80 treated with CS. The efficacy outcomes were clinical efficacy and 30-day mortality, while the safety indicator was acute kidney injury (AKI) incidence.ResultThere was no significant difference between the two drugs in clinical efficacy, 30-day mortality, or overall AKI incidence, but the incidence of stage 3 AKI was significantly higher in the PBS cohort than the CS cohort. Therapeutic drug monitoring (TDM) and trough concentration (Cmin) were significantly associated with clinical efficacy and AKI in both cohorts. Classification and regression tree analysis revealed that Cmin values of ≥0.91 mg/L for PBS and Cmin ≥ 0.53 mg/L for CS were associated with higher clinical efficacy.ConclusionThere is basically no significant difference in the efficacy and safety of PBS and CS. TDM can significantly improve the clinical efficacy of both drugs and reduce the incidence of AKI. TDM is therefore recommended to improve the clinical efficacy while reducing the adverse reactions. |
| format | Article |
| id | doaj-art-ea89a9df34e64d4685cb3293e11e9a5e |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Pharmacology |
| spelling | doaj-art-ea89a9df34e64d4685cb3293e11e9a5e2025-01-03T06:47:29ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-01-011510.3389/fphar.2024.14668881466888Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective studyYijing Zhang0Chuhui Wang1Jiaojiao Chen2Chuqi Bai3Dan Sun4Yulan Qiu5Mengmeng Teng6Yalin Dong7Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaDepartment of Pharmacy, Xi’an Hospital of Traditional Chinese Medicine, Xi’an, Shaanxi, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, ChinaBackgroundPolymyxin B sulfate (PBS) and colistin sulfate (CS) are the last-line treatments for infections caused by multidrug-resistant Gram-negative bacteria, but their efficacy and safety have not been validated. The aims of the current study were to (1) determine their efficacy and safety among critically ill patients and the influencing factors, and (2) determine the relationships of drug exposure with efficacy and safety, to provide evidence for the precision dosing.MethodThis retrospective study included 100 critically ill patients treated with PBS and 80 treated with CS. The efficacy outcomes were clinical efficacy and 30-day mortality, while the safety indicator was acute kidney injury (AKI) incidence.ResultThere was no significant difference between the two drugs in clinical efficacy, 30-day mortality, or overall AKI incidence, but the incidence of stage 3 AKI was significantly higher in the PBS cohort than the CS cohort. Therapeutic drug monitoring (TDM) and trough concentration (Cmin) were significantly associated with clinical efficacy and AKI in both cohorts. Classification and regression tree analysis revealed that Cmin values of ≥0.91 mg/L for PBS and Cmin ≥ 0.53 mg/L for CS were associated with higher clinical efficacy.ConclusionThere is basically no significant difference in the efficacy and safety of PBS and CS. TDM can significantly improve the clinical efficacy of both drugs and reduce the incidence of AKI. TDM is therefore recommended to improve the clinical efficacy while reducing the adverse reactions.https://www.frontiersin.org/articles/10.3389/fphar.2024.1466888/fullpolymyxin Bcolistin sulfatecritically ill patientsmultidrug-resistant Gram-negative bacteriatherapeutic drug monitoring |
| spellingShingle | Yijing Zhang Chuhui Wang Jiaojiao Chen Chuqi Bai Dan Sun Yulan Qiu Mengmeng Teng Yalin Dong Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective study Frontiers in Pharmacology polymyxin B colistin sulfate critically ill patients multidrug-resistant Gram-negative bacteria therapeutic drug monitoring |
| title | Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective study |
| title_full | Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective study |
| title_fullStr | Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective study |
| title_full_unstemmed | Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective study |
| title_short | Efficacy, safety, and therapeutic drug monitoring of polymyxin B sulfate and colistin sulfate in critically ill patients: a real-world retrospective study |
| title_sort | efficacy safety and therapeutic drug monitoring of polymyxin b sulfate and colistin sulfate in critically ill patients a real world retrospective study |
| topic | polymyxin B colistin sulfate critically ill patients multidrug-resistant Gram-negative bacteria therapeutic drug monitoring |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2024.1466888/full |
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