Factors Associated with Successful Treatment of Carbapenem-Resistant Gram-Negative Bacilli Infections Using Intravenous Colistin Sulfate in China: A Real-World Retrospective Study

Weixi Gao,1,2,* Wei Li,1,* Huali Liu,3,* Dong Xu,4 Lei Tian,5 Jinwen Zhang,1 Dong Liu,1 Yan He1 1Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China; 2Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China; 3Cancer Center, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China; 4Department of Infection Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China; 5Clinical Microbiology Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yan He, Email [email protected] Jinwen Zhang, Email [email protected]: To evaluate the efficacy of intravenous colistin sulfate (CS) in the treatment of carbapenem-resistant Gram-negative bacilli (CR-GNB) infections in real-world clinical settings and to identify factors influencing its therapeutic outcomes, with the aim of promoting the rational use of CS.Methods: A retrospective analysis was conducted on the clinical characteristics and treatment outcomes of 174 patients diagnosed with CR-GNB infection who received intravenous CS at our center between January 2021 and December 2023. The study evaluated both clinical efficacy and adverse drug reactions (ADRs).Results: Among the 174 patients, 118 cases (67.8%) demonstrated clinical improvement, and the bacterial clearance rate was 53.9%. Multivariate logistic regression analysis identified several factors significantly associated with treatment efficacy: neurological disease (OR [95% CI]: 0.100 [0.019– 0.541]; p = 0.006), admission to a surgical ward (OR [95% CI]: 0.136 [0.023– 0.801]; p = 0.027), septic shock (OR [95% CI]: 5.147 [1.901– 14.096]; p = 0.001), and empirical use of CS (OR [95% CI]: 4.250 [1.109– 16.291]; p = 0.035). Additionally, 10 cases (5.8%) of acute kidney injury (AKI) were attributed to nephrotoxicity from CS, with 2 cases recovering after discontinuation of the drug.Conclusion: Our findings suggest that intravenous colistin sulfate may be an effective treatment option for CR-GNB infections when used appropriately. However, further studies are required to better understand its real-world efficacy and safety profile.Keywords: polymyxin, colistin, colistin sulfate, real world, carbapenem-resistant gram-negative bacilli, infection, efficacy, nephrotoxicity