Nephrotoxicity caused by polymyxin in the treatment of drug-resistant Gram-negative bacterial infections：a meta-analysis
- VernacularTitle:多黏菌素治疗耐药革兰氏阴性菌感染致肾毒性的Meta分析
- Author:
Xiaojie WANG
1
;
Zhiqiang DONG
2
;
Yuan DONG
2
;
Chunxia ZHANG
2
;
Jing WU
2
;
Chen CHEN
2
Author Information
1. Dept. of Pharmaceutical Clinical Research，the First Affiliated Hospital of Baotou Medical College，Inner Mongolia University of Science & Technology，Inner Mongolian Baotou 014010，China;Dept. of Pharmacy，Baotou Eighth Hospital，Inner Mongolian Baotou 014040，China
2. Dept. of Pharmaceutical Clinical Research，the First Affiliated Hospital of Baotou Medical College，Inner Mongolia University of Science & Technology，Inner Mongolian Baotou 014010，China
- Publication Type:Journal Article
- Keywords:
polymyxin;
nephrotoxicity;
drug-resistant Gram-
- From:
China Pharmacy
2023;34(22):2793-2799
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE To evaluate the incidence of nephrotoxicity in patients with drug-resistant Gram-negative bacterial infections after the use of polymyxin， and to provide evidence-based reference for clinical rational drug use. METHODS PubMed， Embase， Web of Science， the Cochrane Library， Wanfang database， CNKI， VIP and SinoMed were searched to collect randomized controlled trials （RCTs） or cohort studies about the polymyxin （trial group） versus other antibiotics （control group） or polymyxin B （trial group） versus polymyxin E （control group）. After literature screening， data extraction and quality evaluation， RevMan 5.4.1 software was used for meta-analysis. RESULTS A total of 37 studies were included， including 4 RCTs and 33 cohort studies， with a total of 5 871 patients. The meta-analysis results showed that in RCT [RR＝2.64，95%CI （1.43，4.87），P＝0.002] and in cohort studies [RR＝1.59， 95%CI （1.27， 1.98）， P＜0.000 1]， the incidence of nephrotoxicity in the trial group was significantly higher than control group. The results of the subgroup analysis of cohort studies showed that the incidence of nephrotoxicity in the trial group （receiving polymyxin） was significantly higher than control group （receiving new β-lactam and β-lactamase inhibitors and tigecycline）； when Kidney Disease Improving Global Outcomes （KDIGO）， renal replacement therapy or 0.5 times increase in serum creatinine were used as the standard of nephrotoxicity， the incidence of nephrotoxicity in the trial group was significantly higher than the control group （P＜0.05）. The incidence of nephrotoxicity in patients receiving polymyxin E was significantly higher than those using polymyxin B [RR＝0.57， 95%CI （0.39，0.84）， P＝0.005]. CONCLUSIONS In the treatment of drug-resistant Gram-negative bacteria infections， the incidence of nephrotoxicity caused by polymyxin is relatively high. The TYU108F）； incidence of nephrotoxicity caused by polymyxin E is higher than polymyxin B.
