RETROSPECTIVE ANALYSIS ON PATIENTS WITH INFECTION OF MULTIDRUG-RESISTANT ACINETOBACTER BAUMANNII: THE COMBINATION OF POLYMYXIN B AND TIGECYCLINE

Xiao Du^{1, #}, Hanwen Tong^{2, #}, Bin He⁴, Yang Liu^{3, *}, Binxia Shao^{2, *}

¹Department of Pharmacy, Nanjing Medical Center for Clinical Pharmacy, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China - ²Department of Emergency Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China - ³Department of Intensive Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China - ⁴Department of Emergency Medicine, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China

Introduction: To explore the effect of the combination of Polymyxin B and tigecycline in the treatment of infection caused by multidrug-resistant Acinetobacter baumannii. 

Materials and methods: This study retrospectively analyzed the data of patients with infection of multidrug-resistant Acinetobacter baumannii who were admitted to Nanjing Drum Tower Hospital and the First Affiliated Hospital of Nanjing Medical University from January 2016 to January 2021 and treated with the combination of Polymyxin B and tigecycline. According to the dose of polymyxin B administered, the patients were divided into the low-dose group and high-dose group. Statistical analysis was performed on the age, infection site, pre-existing diseases, liver and kidney function, inflammation-associated cytokines, liver function-associated cytokines, kidney function-associated cytokines, microbial culture results and other indicators of the patients. 

Results: Inflammation-associated cytokines, including PCT, CRP and WBC, were significantly decreased in both groups, and the decrease in the high-dose group was significantly higher than that in the low-dose group. The kidney injury-associated cytokines, including Cre, reached the peak value on Day 10, ALB and eGFR reached on Day 5, and the three cytokines were gradually decreased in the subsequent treatment, but the speed in the high-dose group was slower than that in the low-dose group (P<0.05). The liver injury-associated cytokines, including ALT and AST, showed a significant rising trend in both groups, and the rising in the high-dose group was greater than that in the low-dose group (P<0.05). There was no statistical difference in the effective rate between the high-dose group and low-dose group, but the mortality rate in the high-dose group was higher than that of the low-dose group. The results of logistics regression analysis showed that hypertension and diabetes were significantly correlated with the occurrence of kidney injury in the two groups (P<0.05). 

Conclusions: Antibiotic therapy with tigecycline combined with Polymyxin B can increase the incidence of liver and kidney injury in patients with hypertension and/or diabetes, and the resulting liver injury is irreversible, so the selection should be made with caution in clinical application.