Xu HC, Cui Y, Wang XY, Wu HB, Li W, Wang D, Lin N, Lin L, Zhang YH. Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria. World J Clin Cases 2024; 12(13): 2173-2181 [PMID: 38808336 DOI: 10.12998/wjcc.v12.i13.2173]
Corresponding Author of This Article
Yan Cui, MM, Deputy Director, Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, No. 83 Wenhua Road, Shenhe District, Shenyang 110003, Liaoning Province, China. cyan9010@qq.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Case Control Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 6, 2024; 12(13): 2173-2181 Published online May 6, 2024. doi: 10.12998/wjcc.v12.i13.2173
Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria
Hai-Chang Xu, Yan Cui, Xue-Ying Wang, Hai-Bo Wu, Wei Li, Dan Wang, Na Lin, Lin Lin, Ying-Hui Zhang
Hai-Chang Xu, Yan Cui, Xue-Ying Wang, Hai-Bo Wu, Wei Li, Dan Wang, Na Lin, Lin Lin, Ying-Hui Zhang, Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, Shenyang 110016, Liaoning Province, China
Author contributions: Xu HC and Cui Y conceptualized the research project, wrote the paper and checked for scientific accuracy; Wang XY and Wu HB collected data and checked the manuscript for scientific accuracy; Li W and Wang D collected data, performed statistical analyses and checked the manuscript for scientific accuracy; Lin N, Lin L and Zhang YH collected data, performed statistical analyses and checked the manuscript for scientific accuracy.
Institutional review board statement: The study was approved by the Ethics Committee of the People's Liberation Army Northern Theater General Hospital (No: Y2024-016).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There are no conflicts of interest for any of the authors of this study.
Data sharing statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan Cui, MM, Deputy Director, Department of Intensive Care Medicine, The General Hospital of the Northern Theater Command of the People's Liberation Army of China, No. 83 Wenhua Road, Shenhe District, Shenyang 110003, Liaoning Province, China. cyan9010@qq.com
Received: January 25, 2024 Peer-review started: January 25, 2024 First decision: February 8, 2024 Revised: February 27, 2024 Accepted: March 25, 2024 Article in press: March 25, 2024 Published online: May 6, 2024 Processing time: 91 Days and 2.9 Hours
Abstract
BACKGROUND
Multidrug-resistant Gram-negative bacteria, exacerbated by excessive use of antimicrobials and immunosuppressants, are a major health threat.
AIM
To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia, and to provide theoretical reference for clinical diagnosis and treatment.
METHODS
This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June 2022. After bacteriological culture, the patients' airway secretions were collected to confirm the presence of Gram-negative bacilli. The patients were divided into the experimental and control groups according to the medication used. The research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous, nebulization, or intravenous combined with nebulization, with a daily dosage of 1.5–3.0 million units. The control group consisted of 26 patients who received standard dosages of other antibiotics (including sulbactam sodium for injection, cefoperazone sodium sulbactam for injection, tigecycline, meropenem, or vaborbactam).
RESULTS
Of the 28 patients included in the research group, 26 patients showed improvement, treatment was ineffective for two patients, and one patient died, with the treatment efficacy rate of 92.82%. Of the 26 patients in the control group, 18 patients improved, treatment was ineffective for eight patients, and two patients died, with the treatment efficacy rate of 54.9%; significant difference was observed between the two groups (P < 0.05). The levels of white blood cell (WBC), procalcitonin (PCT), and C-reactive protein (CRP) in both groups were significantly lower after treatment than before treatment (P < 0.05), and the levels of WBC, PCT, and CRP in the research group were significantly lower than those in the control group (P < 0.05). Compared with before treatment, there were no significant changes in aspartate aminotransferase, creatinine, and glomerular filtration rate in both groups, while total bilirubin and alanine aminotransferase decreased after treatment (P < 0.05) with no difference between the groups. In patients with good clinical outcomes, the sequential organ failure assessment (SOFA) score was low when treated with inhaled polymyxin sulfate, and specific antibiotic treatment did not improve the outcome. Sepsis and septic shock as well as a low SOFA score were independent factors associated with good clinical outcomes.
CONCLUSION
Polymyxin sulfate has a significant effect on the treatment of patients with multiple drug-resistant Gram-negative bacilli pneumonia and other infections in the lungs and is safe and reliable. Moreover, the administration route of low-dose intravenous injection combined with nebulization shows better therapeutic effects and lower adverse reactions, providing new ideas for clinical administration.
Core Tip: Multidrug-resistant Gram-negative bacteria, exacerbated by excessive use of antimicrobials and immunosuppressants, are a major health threat. Colistin sulfate provides comprehensive, highly sensitive coverage against these bacteria. For pulmonary infections, its use via intravenous and nebulization methods improves cure rates and reduces adverse reactions, including renal and neurotoxicity. It also significantly ameliorates clinical symptoms in sepsis patients, proving to be safe and reliable.
