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. 2020 Aug 19;15(8):e0237880.
doi: 10.1371/journal.pone.0237880. eCollection 2020.

Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance

Thalita Bento Talizin  1   2 , Cláudia Maria Dantas de Maio Carrilho  3 , Cintia Magalhães Carvalho Grion  3 , Lucienne Tibery Queiroz Cardoso  3 , Marcos Toshiyuki Tanita  3 , Karine Maria Boll  3 , Ivanil Aparecida Moro Kauss  3 , Josiane Festti  3 , Camila Ribeiro Lopes  2 , Leticia Maria Alves da Silva  2 , Isabella Patruceli de Azevedo  2 , Késia Paes  2 , Eduardo Alexandrino Medeiros  1
Affiliations

Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance

Thalita Bento Talizin et al. PLoS One. .

Abstract

Objectives: To analyse the use of polymyxins for the treatment of ventilator-associated pneumonia (VAP) at a teaching hospital where carbapenem-resistant gram-negative bacteria are endemic.

Patients and methods: This was a historical cohort study of patients receiving polymyxins to treat VAP in ICUs at a public university hospital in southern Brazil between January 1, 2017 and January 31, 2018.

Results: During the study period, 179 cases of VAP were treated with polymyxins. Of the 179 patients, 158 (88.3%) were classified as having chronic critical illness. Death occurred in 145 cases (81.0%). Multivariate analysis showed that the factors independently associated with mortality were the presence of comorbidities (P<0.001) and the SOFA score of the day of polymyxin prescription (P<0.001). Being a burn patient was a protective factor for mortality (P<0.001). Analysis of the 14-day survival probability showed that mortality was higher among the patients who had sepsis or septic shock at the time of polymyxin prescription (P = 0.028 and P<0.001, respectively). Acinetobacter baumannii was identified as the etiological agent of VAP in 121 cases (67.6%). In our cohort, polymyxin consumption and the incidence density of VAP were quite high.

Conclusions: In our study, comprised primarily of chronically critically ill patients, there was a high prevalence of VAP caused by multidrug-resistant bacteria, consistent with healthcare-associated infections in low- and middle-income countries. Presence of comorbidities and the SOFA score at the time of polymyxin prescription were predictors of mortality in this cohort. Despite aggressive antimicrobial treatment, mortality was high, stressing the need for antibiotic stewardship.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Analysis of the probability of 14-day survival in ICU patients with and without sepsis on the first day of polymyxin administration to treat ventilator-associated pneumonia at the Hospital Universitário da Universidade Estadual de Londrina, in the city of Londrina, Brazil, between January 1, 2017 and January 31, 2018.
Log-rank test, P = 0.0284.
Fig 2
Fig 2. Analysis of the probability of 14-day survival in ICU patients with and without septic shock on the first day of polymyxin administration to treat ventilator-associated pneumonia at the Hospital Universitário da Universidade Estadual de Londrina, in the city of Londrina, Brazil, between January 1, 2017 and January 31, 2018.
Log-rank test, P = 0.0065.
Fig 3
Fig 3. Time series for the distribution of the incidence density of Ventilator-Associated Pneumonia (VAP) and polymyxin consumption, at a Defined Daily Dose (DDD) per 1000 patient-days, in ICUs at the Hospital Universitário da Universidade Estadual de Londrina, in the city of Londrina, Brazil, between January 1, 2017 and January 31, 2018.
VAP, ventilator-associated pneumonia; DDD, defined daily dose.
See this image and copyright information in PMC

References

    1. Padoveze MC, Melo S, Bishop S et al. Public policies on healthcare-associated infections: a Brazil and UK case study. Rev Saude Publica 2017; 51: 119 10.11606/S1518-8787.2017051000315 - DOI - PMC - PubMed
    1. Fortaleza CMCB Padoveze MC, Kiffer CRV et al. Multi-state survey of healthcare-associated infections in acute care hospitals in Brazil. J Hosp Infect 2017; 96: 139–44. 10.1016/j.jhin.2017.03.024 - DOI - PubMed
    1. Braga IA, Campos PA, Gontijo-Filho PP et al. Multi-hospital point prevalence study of healthcare-associated infections in 28 adult intensive care units in Brazil. J Hosp Infect 2018. July; 99(3): 318–24. 10.1016/j.jhin.2018.03.003 - DOI - PubMed
    1. Lynch JP 3rd, Zhanel GG, Clark NM. Infections Due to Acinetobacter baumannii in the ICU: Treatment Options. Semin Respir Crit Care Med 2017. June; 38(3): 311–25. 10.1055/s-0037-1599225 - DOI - PubMed
    1. Tsuji BT, Pogue JM, Zavascki AP et al. International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). Pharmacotherapy 2019. January; 39(1): 10–39. 10.1002/phar.2209 - DOI - PMC - PubMed

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