TABLE 4.
Potential risk factors for infection-related mortality in patients with XDR GNB infections and treated with polymyxin MT or guided and nonguided combination therapy
| Characteristic | Result for patients with: |
P value | |
|---|---|---|---|
| No infection-related mortality (n = 224) | Infection-related mortality (n = 67) | ||
| Demographics | |||
| Median (range) age (yr) | 65 (16–92) | 58 (16–93) | 0.047 |
| No. (%) of male patients | 147 (65.6) | 46 (68.7) | 0.645 |
| No. (%) of patients with the following comorbidities: | |||
| Ischemic heart disease | 42 (18.8) | 22 (32.9) | 0.015 |
| Congestive heart failure | 18 (8.0) | 9 (13.4) | 0.182 |
| Cerebrovascular disease | 19 (8.5) | 12 (17.9) | 0.028 |
| Diabetes mellitus | 83 (37.1) | 29 (43.3) | 0.358 |
| Chronic kidney disease | 53 (23.7) | 24 (35.8) | 0.048 |
| Hepatic disease | 19 (8.5) | 6 (9.0) | 0.904 |
| Malignancy disease | 45 (20.1) | 18 (26.9) | 0.237 |
| Autoimmune disease | 6 (2.7) | 2 (3.0) | 0.893 |
| Immunocompromised | 17 (7.6) | 11 (16.4) | 0.032 |
| Median (range) CCI | 2 (0–14) | 4 (0–10) | <0.001 |
| Median (range) APACHE II score | 12 (0–28) | 18 (9–31) | <0.001 |
| No. (%) of patients with the following primary infection or site of infectiona: | |||
| Central nervous system | 1 (0.4) | 0 (0.0) | 0.584 |
| Nosocomial pneumonia | 73 (32.6) | 45 (67.1) | <0.001 |
| Tracheobronchitis | 4 (1.8) | 0 (0.0) | 0.271 |
| Skin and soft tissue | 85 (37.9) | 21 (31.3) | 0.324 |
| Bone and joint | 21 (9.4) | 2 (3.0) | 0.089 |
| Gastrointestinal system | 11 (4.9) | 3 (4.5) | 0.884 |
| Urinary tract | 29 (12.9) | 7 (10.4) | 0.586 |
| Blood | 62 (27.7) | 26 (38.8) | 0.082 |
| Secondary bacteremia | 35 (15.6) | 19 (28.4) | 0.019 |
| No. (%) of patients in whom the following XDR GNB was responsible for infectionb: | |||
| Acinetobacter baumannii | 171 (76.3) | 57 (85.1) | 0.128 |
| Pseudomonas aeruginosa | 52 (23.2) | 9 (13.4) | 0.084 |
| Klebsiella pneumoniae | 13 (5.8) | 1 (1.5) | 0.148 |
| Othersc | 3 (1.3) | 1 (1.5) | 0.925 |
| Treatment detailsd | |||
| No. (%) of patients who received polymyxin B | 185 (82.6) | 51 (76.1) | 0.235 |
| Median (range) avg no. of IU of polymyxin B/kg/day administered to each patient | 21,919 (2,315–45,977) | 22,189 (3,163–34,231) | 0.971 |
| No. (%) of patients who received i.v. CMS | 34 (15.2) | 13 (19.4) | 0.410 |
| Median (range) avg no. of IU of i.v. CMS/day administered to each patient | 4,000,000 (1,000,000–9,000,000) | 3,050,000 (1,530,000–9,000,000) | 0.410 |
| Median (range) proportion of treatment days with adequate i.v. polymyxin B or i.v. CMS dosese | 0.70 (0.00–1.00) | 0.38 (0.00–1.00) | 0.169 |
| No. (%) of patients who received nebulized CMS | 69 (30.8) | 39 (58.2) | <0.001 |
| Median (range) avg no. of IU of nebulized CMS/day administered to each patient | 6,000,000 (3,000,000–9,000,000) | 6,000,000 (2,860,000–6,000,000) | 0.405 |
| Median (range) proportion of treatment days with adequate nebulized CMS dosese | 1.00 (1.00–1.00) | 1.00 (0.86–1.00) | 0.178 |
| Median (range) duration (days) between XDR culture and treatment | 3 (0–45) | 2 (1–4) | 0.137 |
| No. (%) of patients receiving the following treatment type: | |||
| MT | 45 (20.1) | 13 (19.4) | 0.902 |
| NVCT | 153 (68.3) | 50 (74.6) | 0.323 |
| VCT | 26 (11.6) | 4 (6.0) | 0.183 |
a
There may be multiple primary sites of XDR GNB infection per patient.
b
There may be multiple XDR GNB cultured at each site of infection.
c
Other GNB included Stenotrophomonas maltophilia (n = 1), Enterobacter cloacae (n = 2), Pseudomonas putida (n = 2), a Citrobacter species (n = 1), and an Enterobacter species (n = 1).
d
Patients may have received ≥1 polymyxin in the course of treatment.
e
Proportion of adequate i.v. polymyxin/i.v. CMS/nebulized CMS doses is defined as the proportion of polymyxin treatment days in which each patient received adequate doses of the respective polymyxin.