TABLE 5.
Studies that primarily assessed the efficacy and/or toxicity of intravenous polymyxins
| Reference | Study designa | Infection type (%) | No. of patients treated with colistin | No. of patients in comparator group (description)b | Outcome | Nephrotoxicity (%) | Neurotoxicity (%) |
|---|---|---|---|---|---|---|---|
| Koomanachai et al. (301) | Prospective cohort study | Pneumonia (69), bacteremia (12), intra-abdominal (6), urinary tract (5), skin/soft tissue (6), sinus (1) | 78 (71 infected with A. baumannii and 7 infected with P. aeruginosa) | 15 (other antibiotics) (12 infected with A. baumannii and 3 infected with P. aeruginosa) | Good clinical response, 80.8% for colistin group (C) vs 26.7% for noncolistin group (NC) (P < 0.01); 30-day mortality, 46.2% for C vs 80% for NC (P = 0.03) | 30.8 for C vs 66.7 for NC (P = 0.02) | Nil |
| Reina et al. (451) | Prospective cohort study | Pneumonia (53), bacteremia (16), urinary tract (18), other (catheter, central nervous system [CNS], peritonitis, wound) (13) | 55 (36 infected with A. baumannii and 19 infected with P. aeruginosa) | 130 (other antibiotics, predominantly carbapenems [81%]) (69 infected with A. baumannii and 61 infected with P. aeruginosa) | Improvement on day 6, 15% for C vs 17% for NC; in-hospital mortality, 29% for C vs 26% for NC (P = 0.2); microbiological eradication in pneumonia cases, 93% for C vs 94% for NC | Nil | NA |
| Garnacho-Montero et al. (185) | Prospective cohort study | Pneumonia (100) | 21 (all infected with A. baumannii) | 14 (imipenem-cilastatin with or without another antibiotic) (all infected with A. baumannii) | Cure, 57% for C vs 57% for NC; microbiological eradication, 66.7% (6/9 patients) for C vs 50% (2/4 patients) for NC; pneumonia-related mortality, 38% for C vs 36% for NC | 24 for C vs 43 for NC | Nil |
| Kallel et al. (283) | Prospective case series | Pneumonia (78), urinary tract (8), bacteremia (12), CNS (3) | 78 (43 infected with A. baumannii and 35 infected with P. aeruginosa) | NA | Favorable response (77%) | 9 | One patient developed diffuse muscular weakness in the ICU |
| Falagas et al. (158) | Prospective case series | Pneumonia (30), urinary tract (26), wound (15), peritonitis (11), abdominal (4), cellulitis (4), osteomyelitis (4), catheter (4) | 27 (12 infected with A. baumannii, 17 infected with P. aeruginosa, 5 infected with Klebsiella pneumoniae, and 4 infected with Escherichia coli) | NA | Clinical response, 85%; all-cause mortality, 15% | 7 | NA |
| Goverman et al. (207) | Retrospective case series of pediatric burn patients | Bacteremia (100), pneumonia (21), wound (57), urinary tract (36) | 14 (3 infected with A. baumannii and 11 infected with P. aeruginosa) | NA | Favorable response, 78.6%; mortality, 14.3% | 14.3 (2/14 patients) | Nil |
| Holloway et al. (241) | Retrospective case series | 29 (all infected with A. baumannii) | NA | Clinical cure, 76%; microbiological eradication (evaluable in 21 patients), 81%; crude mortality, 27% | 21 | 6 | |
| Michalopoulos et al. (369) | Retrospective case series | Pneumonia (84), bacteremia (35), urinary tract (23), soft tissue (12), CNS (2) | 43 (8 infected with A. baumannii and 35 infected with P. aeruginosa) | NA | Clinical cure or improvement, 75%; microbiological clearance, 67%; mortality, 28% | 18.6 (8/43 patients) | Nil |
| Sobieszczyk et al. (517) | Retrospective case series | Pneumonia (100) | 25 (29 episodes) (16 A. baumannii infections, 12 P. aeruginosa infections, and 1 Alcaligenes xylosoxidans infection) | NA | Favorable response, 76%; microbiological eradication (evaluable in 22 patients), 41%; end-of-treatment mortality, 21% | 10 | 7 (seizure and weakness) |
| Markou et al. (357) | Retrospective case series | Pneumonia (58), catheter (12), sepsis of unknown origin (15), CNS (4), urinary tract (4), sinusitis (4), empyema (4) | 24 (26 episodes) (6 A. baumannii infections and 20 P. aeruginosa infections) | NA | Clinical response, 73%; 30-day mortality, 42% | 14.3 | Nil |
| Ouderkirk et al. (409) | Retrospective case series | Pneumonia (65), bacteremia (8), abdomen (5), urinary tract (3), bone (3), CNS, drain, pleural effusion (2 [each]), unknown (12) | 60 (46 infected with A. baumannii, 2 infected with P. aeruginosa, 2 polymicrobial infections, and 10 unidentified infections) | NA | Microbiological eradication (evaluable in 41 patients), 88%; mortality, 20% | 14 | NA |
| Levin et al. (327) | Retrospective case series | Pneumonia (33), bacteremia (15), urinary tract (20), CNS (8), surgical site (8), peritonitis (7), catheter (7), otitis media (2) | 59 (60 episodes) (39 A. baumannii infections and 21 P. aeruginosa infections) | NA | Good outcome, 58%; microbiological eradication (evaluable in 29 patients), 93%; mortality, 37% | Renal failure not defined; 37% had worsening of renal function during treatment | Nil |
| Michalopoulos et al. (368) | Case report | Bacteremia (100) | 1 (continuous i.v. infusion) (infected with A. baumannii) | NA | Cure (100%) | Nil | NA |
| Kasiakou et al. (285) | Retrospective case series | Fixation device-related orthopedic infections | 2 | NA | Cure (100%) | Nil | Nil |
a
In most retrospective studies, the majority of patients received colistin with concomitant antibiotic therapy, most commonly a carbapenem.
b
NA, not assessed.