Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection

ABSTRACT Polymyxin B is one of the last resort option for carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection in China. Therefore, the timing of administration of polymyxin is frequently delayed. We collected 40 cases of CRKP bloodstream infections (BSIs) treated with combination...

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Main Authors: Qiqiang Liang, Man Huang, Zhijiang Xu
Format: Article
Language:English
Published: Elsevier 2019-05-01
Series:Brazilian Journal of Infectious Diseases
Subjects:
Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702019000100060&lng=en&tlng=en
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spelling doaj-91af0ba4d48145c09a577507c8660abd2020-11-25T03:21:41ZengElsevierBrazilian Journal of Infectious Diseases1678-43912019-05-01231606510.1016/j.bjid.2018.12.004S1413-86702019000100060Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infectionQiqiang LiangMan HuangZhijiang XuABSTRACT Polymyxin B is one of the last resort option for carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection in China. Therefore, the timing of administration of polymyxin is frequently delayed. We collected 40 cases of CRKP bloodstream infections (BSIs) treated with combinations based on polymyxin B over 30 months. The primary outcome, 30-day mortality rate, was 52.5% (21/40). Early administration of polymyxin B is meant to administer the drug within 48 h of diagnosing bacteremia. Delayed administration was considered when polymyxin B was administered after 48 h of bacteremia onset. Polymyxin B duration and total dosages were similar in the two groups (11.57 days versus 11.76 days, p = 0.919; 1306.52 mg versus 1247.06 mg, p = 0.711). Compared with delayed administration, early use of polymyxin B-based combination therapy had a significant increase in the rate of bacterial clearance (65.22% versus 29.41%, p = 0.025; OR = 0.533) and decreased 30-day mortality (39.13% versus 70.59%, p = 0.045; OR = 0.461) and overall mortality (43.48% versus 82.35%, p = 0.022; OR = 0.321).http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702019000100060&lng=en&tlng=encarbapenem-resistant Klebsiella pneumoniae bloodstream infectionPolymyxin B-based combination therapyDrug use timing
collection DOAJ
language English
format Article
sources DOAJ
author Qiqiang Liang
Man Huang
Zhijiang Xu
spellingShingle Qiqiang Liang
Man Huang
Zhijiang Xu
Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection
Brazilian Journal of Infectious Diseases
carbapenem-resistant Klebsiella pneumoniae bloodstream infection
Polymyxin B-based combination therapy
Drug use timing
author_facet Qiqiang Liang
Man Huang
Zhijiang Xu
author_sort Qiqiang Liang
title Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection
title_short Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection
title_full Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection
title_fullStr Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection
title_full_unstemmed Early use of polymyxin B reduces the mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection
title_sort early use of polymyxin b reduces the mortality of carbapenem-resistant klebsiella pneumoniae bloodstream infection
publisher Elsevier
series Brazilian Journal of Infectious Diseases
issn 1678-4391
publishDate 2019-05-01
description ABSTRACT Polymyxin B is one of the last resort option for carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infection in China. Therefore, the timing of administration of polymyxin is frequently delayed. We collected 40 cases of CRKP bloodstream infections (BSIs) treated with combinations based on polymyxin B over 30 months. The primary outcome, 30-day mortality rate, was 52.5% (21/40). Early administration of polymyxin B is meant to administer the drug within 48 h of diagnosing bacteremia. Delayed administration was considered when polymyxin B was administered after 48 h of bacteremia onset. Polymyxin B duration and total dosages were similar in the two groups (11.57 days versus 11.76 days, p = 0.919; 1306.52 mg versus 1247.06 mg, p = 0.711). Compared with delayed administration, early use of polymyxin B-based combination therapy had a significant increase in the rate of bacterial clearance (65.22% versus 29.41%, p = 0.025; OR = 0.533) and decreased 30-day mortality (39.13% versus 70.59%, p = 0.045; OR = 0.461) and overall mortality (43.48% versus 82.35%, p = 0.022; OR = 0.321).
topic carbapenem-resistant Klebsiella pneumoniae bloodstream infection
Polymyxin B-based combination therapy
Drug use timing
url http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-86702019000100060&lng=en&tlng=en
work_keys_str_mv AT qiqiangliang earlyuseofpolymyxinbreducesthemortalityofcarbapenemresistantklebsiellapneumoniaebloodstreaminfection
AT manhuang earlyuseofpolymyxinbreducesthemortalityofcarbapenemresistantklebsiellapneumoniaebloodstreaminfection
AT zhijiangxu earlyuseofpolymyxinbreducesthemortalityofcarbapenemresistantklebsiellapneumoniaebloodstreaminfection
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