TABLE 5.

Studies that primarily assessed the efficacy and/or toxicity of intravenous polymyxins

ReferenceStudy designaInfection type (%)No. of patients treated with colistinNo. of patients in comparator group (description)bOutcomeNephrotoxicity (%)Neurotoxicity (%)
Koomanachai et al. (301)Prospective cohort studyPneumonia (69), bacteremia (12), intra-abdominal (6), urinary tract (5), skin/soft tissue (6), sinus (1)78 (71 infected with A. baumannii and 7 infected with P. aeruginosa)15 (other antibiotics) (12 infected with A. baumannii and 3 infected with P. aeruginosa)Good clinical response, 80.8% for colistin group (C) vs 26.7% for noncolistin group (NC) (P < 0.01); 30-day mortality, 46.2% for C vs 80% for NC (P = 0.03)30.8 for C vs 66.7 for NC (P = 0.02)Nil
Reina et al. (451)Prospective cohort studyPneumonia (53), bacteremia (16), urinary tract (18), other (catheter, central nervous system [CNS], peritonitis, wound) (13)55 (36 infected with A. baumannii and 19 infected with P. aeruginosa)130 (other antibiotics, predominantly carbapenems [81%]) (69 infected with A. baumannii and 61 infected with P. aeruginosa)Improvement on day 6, 15% for C vs 17% for NC; in-hospital mortality, 29% for C vs 26% for NC (P = 0.2); microbiological eradication in pneumonia cases, 93% for C vs 94% for NCNilNA
Garnacho-Montero et al. (185)Prospective cohort studyPneumonia (100)21 (all infected with A. baumannii)14 (imipenem-cilastatin with or without another antibiotic) (all infected with A. baumannii)Cure, 57% for C vs 57% for NC; microbiological eradication, 66.7% (6/9 patients) for C vs 50% (2/4 patients) for NC; pneumonia-related mortality, 38% for C vs 36% for NC24 for C vs 43 for NCNil
Kallel et al. (283)Prospective case seriesPneumonia (78), urinary tract (8), bacteremia (12), CNS (3)78 (43 infected with A. baumannii and 35 infected with P. aeruginosa)NAFavorable response (77%)9One patient developed diffuse muscular weakness in the ICU
Falagas et al. (158)Prospective case seriesPneumonia (30), urinary tract (26), wound (15), peritonitis (11), abdominal (4), cellulitis (4), osteomyelitis (4), catheter (4)27 (12 infected with A. baumannii, 17 infected with P. aeruginosa, 5 infected with Klebsiella pneumoniae, and 4 infected with Escherichia coli)NAClinical response, 85%; all-cause mortality, 15%7NA
Goverman et al. (207)Retrospective case series of pediatric burn patientsBacteremia (100), pneumonia (21), wound (57), urinary tract (36)14 (3 infected with A. baumannii and 11 infected with P. aeruginosa)NAFavorable response, 78.6%; mortality, 14.3%14.3 (2/14 patients)Nil
Holloway et al. (241)Retrospective case series29 (all infected with A. baumannii)NAClinical cure, 76%; microbiological eradication (evaluable in 21 patients), 81%; crude mortality, 27%216
Michalopoulos et al. (369)Retrospective case seriesPneumonia (84), bacteremia (35), urinary tract (23), soft tissue (12), CNS (2)43 (8 infected with A. baumannii and 35 infected with P. aeruginosa)NAClinical cure or improvement, 75%; microbiological clearance, 67%; mortality, 28%18.6 (8/43 patients)Nil
Sobieszczyk et al. (517)Retrospective case seriesPneumonia (100)25 (29 episodes) (16 A. baumannii infections, 12 P. aeruginosa infections, and 1 Alcaligenes xylosoxidans infection)NAFavorable response, 76%; microbiological eradication (evaluable in 22 patients), 41%; end-of-treatment mortality, 21%107 (seizure and weakness)
Markou et al. (357)Retrospective case seriesPneumonia (58), catheter (12), sepsis of unknown origin (15), CNS (4), urinary tract (4), sinusitis (4), empyema (4)24 (26 episodes) (6 A. baumannii infections and 20 P. aeruginosa infections)NAClinical response, 73%; 30-day mortality, 42%14.3Nil
Ouderkirk et al. (409)Retrospective case seriesPneumonia (65), bacteremia (8), abdomen (5), urinary tract (3), bone (3), CNS, drain, pleural effusion (2 [each]), unknown (12)60 (46 infected with A. baumannii, 2 infected with P. aeruginosa, 2 polymicrobial infections, and 10 unidentified infections)NAMicrobiological eradication (evaluable in 41 patients), 88%; mortality, 20%14NA
Levin et al. (327)Retrospective case seriesPneumonia (33), bacteremia (15), urinary tract (20), CNS (8), surgical site (8), peritonitis (7), catheter (7), otitis media (2)59 (60 episodes) (39 A. baumannii infections and 21 P. aeruginosa infections)NAGood outcome, 58%; microbiological eradication (evaluable in 29 patients), 93%; mortality, 37%Renal failure not defined; 37% had worsening of renal function during treatmentNil
Michalopoulos et al. (368)Case reportBacteremia (100)1 (continuous i.v. infusion) (infected with A. baumannii)NACure (100%)NilNA
Kasiakou et al. (285)Retrospective case seriesFixation device-related orthopedic infections2NACure (100%)NilNil
  • a In most retrospective studies, the majority of patients received colistin with concomitant antibiotic therapy, most commonly a carbapenem.

  • b NA, not assessed.