Multidrug-Resistant Bacterial Infections
Infections caused by bacteria resistant to multiple antibiotic classes. Includes carbapenem-resistant Enterobacteriaceae (CRE), MDR Pseudomonas aeruginosa, MDR Acinetobacter baumannii, and extensively drug-resistant (XDR) gram-negative pathogens. Mortality 30-70% depending on organism and site.
Quick Answer
What it is
Infections caused by bacteria resistant to multiple antibiotic classes. Includes carbapenem-resistant Enterobacteriaceae (CRE), MDR Pseudomonas aeruginosa, MDR Acinetobacter baumannii, and extensively drug-resistant (XDR) gram-negative pathogens.
Key findings
- Grade A: Carbapenem-Resistant GNB Infections (Polymyxin B)
- Grade A: MDR Pseudomonas aeruginosa (Polymyxin B)
- Grade A: MDR Acinetobacter baumannii (Polymyxin B)
Safety
- Risk factors: duration of use, BMI, advanced age, concomitant nephrotoxins.
- Lower nephrotoxicity risk in pediatric population.
ℹ️ Quick Facts
Quick Facts: Multidrug-Resistant Bacterial Infections
- Supplements Studied:2
2 supps · 10 outcomes
Detailed Outcomes
A
Carbapenem-Resistant GNB Infections
Prospective multicenter study (n=312): 14-day survival 70.5% for CRGNB infections. Site-specific outcomes: LRTI 67.7%, IAI 80.3%, BSI 69.7% survival. Last-resort efficacy against otherwise untreatable MDR pathogens.
moderate↑Improves
A
MDR Pseudomonas aeruginosa
Rapid bactericidal activity against MDR P. aeruginosa with low acquired resistance rates. MIC90 generally 1-2 mg/L. Essential option when all other antipseudomonal agents have failed.
moderate↑Improves
A
MDR Acinetobacter baumannii
Retained activity against extensively drug-resistant A. baumannii. Organism cleared in 88% of patients in clinical studies. Critical therapy for nosocomial Acinetobacter infections.
moderate↑Improves
A
Nephrotoxicity Risk
SAFETY CONCERN: AKI incidence 35-60% across studies. Risk factors: duration of use, BMI, advanced age, concomitant nephrotoxins. Generally reversible upon discontinuation. Possibly milder than colistin-associated nephrotoxicity.
moderate↑Worsens
B
Pediatric Efficacy
Population PK study (n=19 pediatric patients): Clinical success 73.7% with only 5.3% AKI rate. Weight-based dosing (1.33-2.53 mg/kg/day). Lower nephrotoxicity risk in pediatric population.
moderate↑Improves
A
MDR Gram-Negative Infections
Meta-analysis of 5 RCTs (n=377): Effective last-resort option for MDR infections. Cochrane reviews support use for pneumonia, BSI. Clinical success 59.5% in PK study. WHO Essential Medicine designation.
moderate↑Improves
A
Ventilator-Associated Pneumonia
Most common indication in RCTs. Nebulized colistin shows similar efficacy to IV with potentially less nephrotoxicity. Clinical cure rates comparable to β-lactam regimens.
moderate↑Improves
A
Nephrotoxicity Incidence
SAFETY CONCERN: Meta-analysis: 36.2% nephrotoxicity vs 15% comparators (RR 2.40, NNH=5). Comprehensive study (n=178): 44.9% incidence. Median onset 4-6 days. 75% recovery within 10 days of discontinuation. Reversible tubular damage.
large↑Worsens
B
Pediatric/Neonatal Infections
Systematic review (17 studies, n=312 neonates/infants): Effective for BSI, pneumonia, meningitis. Doses 25,000-225,000 IU/kg/day. PK studies suggest >150,000 IU/kg/day needed. Limited nephrotoxicity data in children.
moderate↑Improves
B
Neurotoxicity Risk
SAFETY CONCERN: Neurotoxicity reported including paresthesias, ataxia, neuromuscular blockade. Appears reversible upon discontinuation or dose reduction. Less common than nephrotoxicity.
small↑Worsens