Efficacy of colistin methanesulfonate sodium on carbapenem-resistant organisms
Objective To compare the efficacy and safety of colistin methanesulfonate sodium(CMS)injection and polymyxin B(PMB)injection in treatment of carbapenem-resistant organisms(CRO)infection,and to explore the optimal administration method of CMS and the influencing factors of ineffective CMS aerosol inhalation in the treatment of CRO pulmonary infection.Methods A total of 184 patients with CRO infection were diagnosed and treated in the First Affiliated Hospital of Henan University of Science and Technology from January 2022 to June 2023,and were divided into PMB group(n=92)and CMS group(n=92).The clinical effective rate,bacterial clearance rate,incidence of nephrotoxicity,time of nephrotoxicity onset and 28-d fatality rate were compared between two groups.In CMS group,84 patients developed pulmonary infection,among whom 19 patients received intravenous drip,42 patients received aerosol inhalation,and 23 patients received intravenous drip combined with aerosol inhalation;the clinical effective rate,bacterial clearance rate,and incidence of nephrotoxicity were compared among these three treatment methods.Forty-two patients receiving aerosol inhalation were divided into effective group(n=31)and ineffective group(n=11),and the clinical data as clinical pulmonary infection score(CPIS)and microbial species were compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of ineffective CMS aerosol inhalation in patients with CRO pulmonary infection.Results The clinical effective rate was higher in PMB group(82.61％)than that in CMS group(65.22％)(x2=7.216,P=0.007).No significant differences were found in the bacterial clearance rate,28-d fatality rate,incidence of nephrotoxicity and time of nephrotoxicity onset between PMB group[34.78％,44.57％,11.96％,(6.18±5.32)d]and CMS group[44.57％,33.70％,19.57％,(4.61±3.63)d](x2=1.839,P=0.175;x2=2.282,P=0.131;x2=2.006,P=0.157;x2=0.946,P=0.352).The clinical effective rate of aerosol inhalation(73.81％)was higher than that of intravenous drip(42.11％)and intravenous drip combined with aerosol inhalation(47.83％)(x2=5.703,P=0.017;x2=4.388,P=0.036),and showed no significant difference between intravenous drip and intravenous drip combined with aerosol inhalation(x2=0.137,P=0.711).The incidence of nephrotoxicity of aerosol inhalation(4.76％)was lower than that of intravenous drip(21.05％)and intravenous drip combined with aerosol inhalation(52.17％)(x2=3.914,P=0.047;x2=19.768,P＜0.001),and was lower of intravenous drip than that of intravenous drip combined with aerosol inhalation(x2=4.273,P=0.039).There was no significant difference in bacterial clearance rate among these three treatment methods(x2=3.662,P=0.105).The CPIS(9.09±1.30)and the infection rates of Acinetobacter baumannii and Pseudomonas aeruginosa(72.73％,36.36％)in ineffective group were higher than those in effective group(7.83±1.54,35.48％,9.68％)(t=2.372,P=0.022;x2=4.546,P=0.033;x2=4.163,P=0.041).Acinetobacter baumannii(OR=0.045,95％CI:0.003-0.602,P=0.019)and Pseudomonas aeruginosa(OR=0.017,95％CI:0.001-0.341,P=0.008)were the influencing factors of ineffective CMS aerosol inhalation in patients with CRO pulmonary infection.Conclusions PMB is superior to CMS in the treatment of CRO infection,and the safety of them two shows no significant difference.CMS aerosol inhalation is the optimal administration method for CRO pulmonary infection.Acinetobacter baumannii and Pseudomonas aeruginosa indicate a high risk of ineffective CMS aerosol inhalation.
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