Advertisement

Colistin and polymyxin B for treatment of nosocomial infections in intensive care unit patients: pharmacoeconomic analysis

  • Júlia Coelho França Quintanilha
  • Natalia da Costa Duarte
  • Gustavo Rafaini Lloret
  • Marília Berlofa Visacri
  • Karen Prado Herzer Mattos
  • Desanka Dragosavac
  • Antonio Luis Eiras Falcão
  • Patricia Moriel
Research Article
  • 29 Downloads

Abstract

Background The emergence and rapid spread of multidrug-resistant gram-negative bacteria related to nosocomial infections is a growing worldwide problem, and polymyxins have become important due to the lack of new antibiotics. Objectives To evaluate the outcomes and pharmacoeconomic impact of using colistin and polymyxin B to treat nosocomial infections. Setting Neurosurgical, cardiovascular, or transplantation intensive care unit (ICU) at the Clinical Hospital of the University of Campinas (São Paulo, Brazil). Method A retrospective cohort study was conduct in patients in the ICU. The renal function was determined daily during treatment by measuring the serum creatinine. A cost minimization analysis was performed to compare the relative costs of treatment with colistin and polymyxin B. Main outcomes measure The outcomes were 30-day mortality and frequency and onset of nephrotoxicity after beginning treatment. Results Fifty-one patients treated with colistin and 51 with polymyxin B were included. 30-day mortality was observed in 25.49% and 33.33% of patients treated with colistin and polymyxin B, respectively; Nephrotoxicity was observed in 43.14% and 54.90% of patients in colistin and polymyxin B groups, respectively; and onset time of nephrotoxicity was 9.86 ± 13.22 days for colistin and 10.68 ± 9.93 days for polymyxin B group. Colistin treatment had a lower cost per patient compared to the cost for polymyxin B treatment (USD $13,389.37 vs. USD $13,639.16, respectively). Conclusion We found no difference between 30-day mortality and nephrotoxicity between groups; however, colistin proved to be the best option from a pharmacoeconomic point of view.

Keywords

Brazil Colistin Hospital infection Intensive care Multidrug-resistant bacteria Nephrotoxicity Pharmacoeconomics Polymyxin B 

Notes

Acknowledgements

The authors would like to thank the statistical office of School of Medical Sciences of University of Campinas (UNICAMP) for performing this statistical analysis.

Funding

This work was supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) (Grant Numbers 164796/2014-2 and 02P4353/2015 to G.F.L).

Conflicts of interest

The Authors declare no conflict of interest.

References

  1. 1.
    Barnett AG, Page K, Campbell M, Martin E, Rashleigh-Rolls R, Halton K, et al. The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case-control study. BMJ Open. 2013;3:e003587.CrossRefGoogle Scholar
  2. 2.
    Biswas S, Brunel JM, Dubus JC, Reynaud-Gaubert M, Rolain JM. Colistin: an update on the antibiotic of the 21 st century. Expert Rev Anti Infect Ther. 2012;10:917–34.CrossRefGoogle Scholar
  3. 3.
    Michalopoulos AS, Karatza DC. Multidrug-resistant Gram-negative infections: the use of colistin. Expert Rev Anti Infect. 2010;8:1009–17.CrossRefGoogle Scholar
  4. 4.
    Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323–9.CrossRefGoogle Scholar
  5. 5.
    Zavascki AP, Goldani LZ, Cao G, Superti SV, Lutz L, Barth AL, et al. Pharmacokinetics of intravenous polymyxin B in critically ill patients. Clin Infect Dis. 2008;47:1298–304.CrossRefGoogle Scholar
  6. 6.
    Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K. Evaluation of colistin as an agent against multi-resistant gram-negative bacteria. Int J Antimicrob Agents. 2005;25:11–25.CrossRefGoogle Scholar
  7. 7.
    Li J, Nation RL, Turnidge JD, Milne RW, Coulthard K, Rayner CR, et al. Colistin: the re-emerging antibiotic for multidrug-resistant gram-negative bacterial infections. Lancet Infect Dis. 2006;6:589–601.CrossRefGoogle Scholar
  8. 8.
    Phe K, Lee Y, McDaneld PM, Prasad N, Yin T, Figueroa DA, Musick WL, Cottreau JM, Hu M, Tam VH. In vitro assessment and multicentre cohort study of comparative nephrotoxicity rates associated with colistimethate versus Polymyxin B therapy. Antimicrob Agents Chemother. 2014;58:2740–6.CrossRefGoogle Scholar
  9. 9.
    Akajagbor DS, Wilson SL, Shere-Wolfe KD, Dakum P, Charurat ME, Gilliam BL. Higher incidence of acute kidney injury with intravenous colistimethate sodium compared with Polymyxin B in critically ill patients at a tertiary care medical center. Clin Infect Dis. 2013;57:1300–3.CrossRefGoogle Scholar
  10. 10.
    Tuon FF, Rigatto MH, Lopes CK, Kamei LK, Rocha JL, Zavascki AP. Risk factors for acute kidney injury in patients treated with polymyxin B or colistin methanesulfonate sodium. Int J Antimicrob Agents. 2014;43:349–52.CrossRefGoogle Scholar
  11. 11.
    Rigatto MH, Behle TF, Falci DR, Freitas T, Lopes NT, Nunes M, Costa LW, Zavascki AP. Risk factors for acute kidney injury (AKI) in patients treated with polymyxin B and influence of AKI on mortality: a multicentre prospective cohort study. J Antimicrob Chemother. 2015;70:1552–7.CrossRefGoogle Scholar
  12. 12.
    CLSI Subcommittee On Antimicrobial Susceptibility Testing CLSI AST News Update. 2016. https://clsi.org/media/1700/clsi-news-winter-2016.pdf. Accessed Sept 2018.
  13. 13.
    Birmingham MC, Hassett JM, Schentag JJ, Paladino JA. Assessing antibacterial pharmacoeconomics in the intensive care unit. Pharmacoeconomics. 1997;12:637–47.CrossRefGoogle Scholar
  14. 14.
    Garonzik SM, Li J, Thamlikitkul V, Paterson DL, Shoham S, Jacob J, et al. Population pharmacokinetics of colistin methanesulfonate and formed colistin in critically ill patients from a multicenter study provide dosing suggestions for various categories of patients. Antimicrob Agents Chemother. 2011;55:3284–94.CrossRefGoogle Scholar
  15. 15.
    Pogue JM, Ortwine JK, Kaye KS. Clinical considerations for optimal use of the polymyxins: a focus on agent selection and dosing. Clin Microbiol Infect. 2017;23:229–33.CrossRefGoogle Scholar
  16. 16.
    Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–41.CrossRefGoogle Scholar
  17. 17.
    Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. 23th informational supplement M100-S23 2013; Wayne, CLSI.Google Scholar
  18. 18.
    Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.CrossRefGoogle Scholar
  19. 19.
    Leung KCW, Tonelli M, James MT. Chronic kidney disease following acute kidney injury-risk and outcomes. Nat Rev Nephrol. 2013;9:77–85.CrossRefGoogle Scholar
  20. 20.
    National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–266.Google Scholar
  21. 21.
    Citizen’s Calculator—Central Bank of Brazil. 2018. https://www3.bcb.gov.br/CALCIDADAO/publico/exibirFormCorrecaoValores.do?method=exibirFormCorrecaoValores. Accessed Oct 2018.
  22. 22.
    Brazilian Drugs Market Regulation Chamber (CMED). Products price list, January 2015.Google Scholar
  23. 23.
    Brazilian Unified Health System (SUS). Price table, January 2015.Google Scholar
  24. 24.
    Gomes EC, Falci DR, Bergo P, Zavascki AP, Rigatto MH. Impact of polymyxin-B-associated acute kidney injury in 1-year mortality and renal function recovery. Int J Antimicrob Agents. 2018;52:86–9.CrossRefGoogle Scholar
  25. 25.
    Landman D, Georgescu C, Martin DA, Quale J. Polymyxins revisited. Clin Microbiol Rev. 2008;21:449–65.CrossRefGoogle Scholar
  26. 26.
    Kassamali Z, Danziger L. To B or not to B, that is the question: is it time to replace colistin with polymyxin B? Pharmacotherapy. 2015;35:1–27.CrossRefGoogle Scholar
  27. 27.
    Falagas ME, Kasiakou SK. Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Crit Care. 2006;10:R27.CrossRefGoogle Scholar
  28. 28.
    Vardakas KZ, Falagas ME. Colistin versus polymyxin B for the treatment of patients with multidrug-resistant Gram negative infections: a systematic review and meta-analysis. Int J Antimicrob Agents. 2017;49:233–8.CrossRefGoogle Scholar
  29. 29.
    Justo JA, Bosso JA. Adverse reactions associated with systemic polymyxin therapy. Pharmacotherapy. 2005;35:28–33.CrossRefGoogle Scholar
  30. 30.
    Oliveira MS, Prado GV, Costa SF, Grinbaum RS, Levin AS. Polymyxin B and colistimethate are comparable as to efficacy and renal toxicity. Diagn Microb Infect Dis. 2009;65:431–4.CrossRefGoogle Scholar
  31. 31.
    Rigatto MH, Oliveira MS, Perdigão-Neto MT, Levin AS, Carrilho CM, Tanita MT, et al. Multicenter prospective cohort study of renal failure in patients treated with colistin versus polymyxin B. Antimicrob Agents Chemother. 2016;60:2443–9.CrossRefGoogle Scholar
  32. 32.
    Kwa AL, Tam VH, Falagas ME. Polymyxins: a review of the current status including recent developments. Ann Acad Med Singap. 2008;37:870–83.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Júlia Coelho França Quintanilha
    • 1
  • Natalia da Costa Duarte
    • 1
  • Gustavo Rafaini Lloret
    • 1
  • Marília Berlofa Visacri
    • 1
  • Karen Prado Herzer Mattos
    • 1
  • Desanka Dragosavac
    • 1
  • Antonio Luis Eiras Falcão
    • 1
  • Patricia Moriel
    • 2
  1. 1.School of Medical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil
  2. 2.Faculty of Pharmaceutical SciencesUniversity of Campinas (UNICAMP)CampinasBrazil

Personalised recommendations