Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences · 2026
Clinical efficacy and risk factors of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli infections: A retrospective study.
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Xie Yueliang, Jin Xin, Wang Hui, Yan Shanshan, Liang Junhao, Peng Yue
Аннотация
OBJECTIVES: Infections caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) have become a global public health concern because of their high incidence and mortality. Although intravenous colistin sulfate has been widely used for the treatment of CR-GNB infections, systematic evaluations of its clinical efficacy and safety remain limited. This study aims to evaluate the clinical efficacy and safety of colistin sulfate in the treatment of CR-GNB infections and to analyze factors associated with therapeutic efficacy and prognosis, thereby providing evidence for rational clinical use and improved patient outcomes.
METHODS: Clinical data of patients from the Third Xiangya Hospital of Central South University who received intravenous colistin sulfate for CR-GNB infections between July 2020 and March 2023 were retrospectively collected, including demographic characteristics, infection-related information (infection sites, pathogens, and antimicrobial susceptibility results), concomitant medications (drug type, dosage, and treatment duration), laboratory findings, and patient outcomes. The clinical efficacy and safety of colistin sulfate for CR-GNB infections were evaluated, and the 30‑day all‑cause mortality and microbiological eradication rate were analyzed. Multivariable Logistic regression analysis was performed to identify independent risk factors affecting the clinical efficacy of colistin sulfate treatment and to construct a predictive model. The predictive performance of the model was assessed using the area under the receiver operating characteristic curve (AUROC). Kaplan‑Meier curves and Cox regression models were used to analyze factors associated with 30-day all-cause mortality.
RESULTS: A total of 112 patients with CR-GNB infections were included. Among them, 85.7% were admitted to the intensive care unit (ICU), 67.9% received mechanical ventilation, and 51.8% required vasopressor support. The lung was the most common site of infection (81.3%), followed by bloodstream infection (17.0%). The predominant pathogens were Klebsiella pneumoniae (69.6%) and Acinetobacter baumannii (60.7%), and 72 (64.3%) patients were infected with 2 or more pathogens. All patients received combination therapy with colistin sulfate, most commonly in combination with carbapenems (75.0%). After treatment, the overall clinical response rate was 67.0%, the microbiological eradication rate was 48.8%, and the 30‑day all‑cause mortality rate was 28.6%. The clinical response rates and 30‑day all‑cause mortality rates were generally similar among different combination regimens. Colistin sulfate combined with carbapenems achieved the highest clinical response rate (56/84, 66.7%), whereas colistin sulfate combined with ceftazidime‑avibactam showed the lowest clinical response rate (9/17, 52.9%) but the lowest 30‑day all‑cause mortality rate (4/17, 23.5%). In addition, 16 (16/90, 17.8%) patients developed acute kidney injury during treatment, and 16 (16/112, 14.3%) patients developed colistin resistance among CR‑GNB isolates during hospitalization. The multivariate Logistic regression model was established as follows: Y (clinical efficacy)=2.174-0.031×(age)-1.510×(mechanical ventilation)-1.720×(continuous renal replacement therapy)+0.004×(platelet count)+1.908×(treatment duration≥7 d). The AUROC was 0.840 (95% CI 0.761 to 0.919), indicating good predictive performance, and the calibration curve showed good model fit (Hosmer-Lemeshow χ2=5.909, P=0.657). Cox regression analysis demonstrated that a higher baseline platelet count (adjusted HR=0.99, 95% CI 0.99 to 1.00, P=0.029) and treatment duration ≥7 d (adjusted HR=0.31, 95% CI 0.11 to 0.90, P=0.031) were independently associated with lower 30-day all-cause mortality.
CONCLUSIONS: Colistin sulfate is effective in the treatment of CR-GNB infections. Treatment duration ≥7 d is an independent factor associated with improved clinical efficacy and survival. During adequate treatment courses, the emergence of colistin resistance should be closely monitored, and combination regimens should be selected according to antimicrobial susceptibility results.
METHODS: Clinical data of patients from the Third Xiangya Hospital of Central South University who received intravenous colistin sulfate for CR-GNB infections between July 2020 and March 2023 were retrospectively collected, including demographic characteristics, infection-related information (infection sites, pathogens, and antimicrobial susceptibility results), concomitant medications (drug type, dosage, and treatment duration), laboratory findings, and patient outcomes. The clinical efficacy and safety of colistin sulfate for CR-GNB infections were evaluated, and the 30‑day all‑cause mortality and microbiological eradication rate were analyzed. Multivariable Logistic regression analysis was performed to identify independent risk factors affecting the clinical efficacy of colistin sulfate treatment and to construct a predictive model. The predictive performance of the model was assessed using the area under the receiver operating characteristic curve (AUROC). Kaplan‑Meier curves and Cox regression models were used to analyze factors associated with 30-day all-cause mortality.
RESULTS: A total of 112 patients with CR-GNB infections were included. Among them, 85.7% were admitted to the intensive care unit (ICU), 67.9% received mechanical ventilation, and 51.8% required vasopressor support. The lung was the most common site of infection (81.3%), followed by bloodstream infection (17.0%). The predominant pathogens were Klebsiella pneumoniae (69.6%) and Acinetobacter baumannii (60.7%), and 72 (64.3%) patients were infected with 2 or more pathogens. All patients received combination therapy with colistin sulfate, most commonly in combination with carbapenems (75.0%). After treatment, the overall clinical response rate was 67.0%, the microbiological eradication rate was 48.8%, and the 30‑day all‑cause mortality rate was 28.6%. The clinical response rates and 30‑day all‑cause mortality rates were generally similar among different combination regimens. Colistin sulfate combined with carbapenems achieved the highest clinical response rate (56/84, 66.7%), whereas colistin sulfate combined with ceftazidime‑avibactam showed the lowest clinical response rate (9/17, 52.9%) but the lowest 30‑day all‑cause mortality rate (4/17, 23.5%). In addition, 16 (16/90, 17.8%) patients developed acute kidney injury during treatment, and 16 (16/112, 14.3%) patients developed colistin resistance among CR‑GNB isolates during hospitalization. The multivariate Logistic regression model was established as follows: Y (clinical efficacy)=2.174-0.031×(age)-1.510×(mechanical ventilation)-1.720×(continuous renal replacement therapy)+0.004×(platelet count)+1.908×(treatment duration≥7 d). The AUROC was 0.840 (95% CI 0.761 to 0.919), indicating good predictive performance, and the calibration curve showed good model fit (Hosmer-Lemeshow χ2=5.909, P=0.657). Cox regression analysis demonstrated that a higher baseline platelet count (adjusted HR=0.99, 95% CI 0.99 to 1.00, P=0.029) and treatment duration ≥7 d (adjusted HR=0.31, 95% CI 0.11 to 0.90, P=0.031) were independently associated with lower 30-day all-cause mortality.
CONCLUSIONS: Colistin sulfate is effective in the treatment of CR-GNB infections. Treatment duration ≥7 d is an independent factor associated with improved clinical efficacy and survival. During adequate treatment courses, the emergence of colistin resistance should be closely monitored, and combination regimens should be selected according to antimicrobial susceptibility results.