Colistin Sulfate-Based Combination Therapy for Infections Caused by Carbapenem-Resistant Organisms in Intensive Care Units: A Multicenter, Prospective, Observational Clinical Trial

作者：Fan Zhang, Danyang Peng, Faming He, Ying Liu, Binbin Zang, Yanqiu Gao, Chao Qin, Suping Guo, Yawei Qi, Xisheng Zheng, Lin Guo, Tingting Zhao, Yue Jin, Rachel Su, Juan Du, Jiazhan Pan, Bingyu Qin, Huanzhang Shao · 发表于：Infectious Diseases and Therapy · 年份：2025 · DOI：10.1007/s40121-025-01176-5 · 被引用次数：4 · 研究领域：Antibiotic Resistance in Bacteria、Antibiotics Pharmacokinetics and Efficacy、Nosocomial Infections in ICU

INTRODUCTION: With the rapid spread of carbapenem-resistant Gram-negative bacterial infections, polymyxins have reemerged as a critical "salvage" antibiotic option. METHODS: This multicenter observational study assessed the effectiveness and safety of colistin sulfate-based treatment for carbapenem-resistant organism (CRO) infections in patients in intensive care across ten clinical sites in China. Clinical and microbiological responses, 28-day all-cause mortality, and associated risk factors were analyzed. Nephrotoxicity was assessed using Kidney Disease Improving Global Outcomes (KDIGO) criteria. RESULTS: Of 240 critically ill adult patients with confirmed CRO infection, 91.3% had pulmonary infection, and 77.1% and 52.5% achieved clinical and microbiological response, respectively. Subgroup analyses showed associations between outcomes and patient age and colistin sulfate treatment duration. The 28-day all-cause mortality was 27.1%. Clinical response and mortality were significantly associated with Sequential Organ Failure Assessment (SOFA) score and colistin sulfate treatment duration. Analysis of the receiver operating characteristic (ROC) curve revealed that the thresholds for colistin treatment duration for predicting clinical response and survival were > 9.5 days (area under the curve [AUC] > 0.7). Nephrotoxicity was reported in 13.1% of patients not receiving continuous renal replacement therapy (CRRT), with no significant duration-dependent increase. Post-treatment s...