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

CharacteristicResult 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 patients147 (65.6)46 (68.7)0.645
No. (%) of patients with the following comorbidities:
    Ischemic heart disease42 (18.8)22 (32.9)0.015
    Congestive heart failure18 (8.0)9 (13.4)0.182
    Cerebrovascular disease19 (8.5)12 (17.9)0.028
    Diabetes mellitus83 (37.1)29 (43.3)0.358
    Chronic kidney disease53 (23.7)24 (35.8)0.048
    Hepatic disease19 (8.5)6 (9.0)0.904
    Malignancy disease45 (20.1)18 (26.9)0.237
    Autoimmune disease6 (2.7)2 (3.0)0.893
    Immunocompromised17 (7.6)11 (16.4)0.032
Median (range) CCI2 (0–14)4 (0–10)<0.001
Median (range) APACHE II score12 (0–28)18 (9–31)<0.001
No. (%) of patients with the following primary infection or site of infectiona:
    Central nervous system1 (0.4)0 (0.0)0.584
    Nosocomial pneumonia73 (32.6)45 (67.1)<0.001
    Tracheobronchitis4 (1.8)0 (0.0)0.271
    Skin and soft tissue85 (37.9)21 (31.3)0.324
    Bone and joint21 (9.4)2 (3.0)0.089
    Gastrointestinal system11 (4.9)3 (4.5)0.884
    Urinary tract29 (12.9)7 (10.4)0.586
    Blood62 (27.7)26 (38.8)0.082
    Secondary bacteremia35 (15.6)19 (28.4)0.019
No. (%) of patients in whom the following XDR GNB was responsible for infectionb:
    Acinetobacter baumannii171 (76.3)57 (85.1)0.128
    Pseudomonas aeruginosa52 (23.2)9 (13.4)0.084
    Klebsiella pneumoniae13 (5.8)1 (1.5)0.148
    Othersc3 (1.3)1 (1.5)0.925
Treatment detailsd
    No. (%) of patients who received polymyxin B185 (82.6)51 (76.1)0.235
    Median (range) avg no. of IU of polymyxin B/kg/day administered to each patient21,919 (2,315–45,977)22,189 (3,163–34,231)0.971
    No. (%) of patients who received i.v. CMS34 (15.2)13 (19.4)0.410
    Median (range) avg no. of IU of i.v. CMS/day administered to each patient4,000,000 (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 dosese0.70 (0.00–1.00)0.38 (0.00–1.00)0.169
    No. (%) of patients who received nebulized CMS69 (30.8)39 (58.2)<0.001
    Median (range) avg no. of IU of nebulized CMS/day administered to each patient6,000,000 (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 dosese1.00 (1.00–1.00)1.00 (0.86–1.00)0.178
    Median (range) duration (days) between XDR culture and treatment3 (0–45)2 (1–4)0.137
No. (%) of patients receiving the following treatment type:
    MT45 (20.1)13 (19.4)0.902
    NVCT153 (68.3)50 (74.6)0.323
    VCT26 (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.