Colistin Methanesulfonate Is Efficacious and Safe for the Management of Sepsis in Hematological Diseases Patients: A Retrospective Study in China
Authors: Xie Yan , Liu Ziyi , Liang Peiqi , Wu Depei , Fu Jianhong 
Published: December 2024

Background: Patients afflicted with hematological diseases are at an elevated risk of infection, with the potential for the development of sepsis. The emergence of carbapenem-resistant organism (CRO) in patients with hematological diseases presents a significant challenge to the management of sepsis. Colistin methanesulfonate (CMS) has been demonstrated to possess notable antibacterial activity against CRO pathogens. Nevertheless, the clinical evidence of CMS for treating sepsis in patients with hematological diseases remains limited. This study aims to analyze the efficacy and safety of CMS in the management of sepsis in Chinese patients with hematological diseases.

Methods: A retrospective study was conducted on hematological diseases patients diagnosed as sepsis and treated with CMS at the First Affiliated Hospital of Soochow University in Jiangsu between November 2021 and July 2023. Demographics, clinical presentation, causative organisms, clinical outcomes and adverse events (AEs) were recorded. The clinical outcomes were evaluated by clinical effective rate, bacteriological eradication rate, 28-day all-cause mortality rate, the length of intensive care unit (ICU) stay and total in-hospital stay, and the incidence of renal insufficiency. The univariate and multivariate analysis was conducted to identify predictive factors for clinical efficacy and renal insufficiency.

Results: A total of 81 hematological patients diagnosed with sepsis were included, the mean age of patients was 45.21 ± 14.55 years, and 61.73% were male. Leukemia (66.67%) represents the most prevalent hematological disease. Among the 81 patients, 63 (77.78%) were diagnosed with a causative organism infection. 34 patients developed CRO infection, of which carbapenem-resistant Klebsiella pneumonia (19/34, 55.88%) was the most causative organism. The mean sequential organ failure assessment (SOFA) score when utilizing CMS was 3.90 ± 2.10. Following CMS treatment, a clinical effective rate was observed in 62.96% of patients, while the bacteriological eradication rate was 59.26%. Additionally, the 28-day all-cause mortality rate was 29.63%. The median length of stay in the ICU and total in-hospital stay was 13.5 and 33 days, respectively. AEs were reported in 16 patients, including 15 (18.52%) renal insufficiency, 1 (1.23%) hepatic insufficiency, and 1 (1.23%) rashes. The multivariate analysis of clinical effective indicated that a higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, a higher Charlson comorbidity index, the recurrence or refractoriness of hematological diseases, and the use of mechanical ventilation was independently associated with a poor clinical efficacy. The univariate analysis of renal insufficiency demonstrated that allogeneic hematopoietic stem cell transplantation, aplastic anemia, and gastrointestinal infection had a statistically significant impact on renal function in hematological diseases patients.

Conclusions: The findings of our study demonstrated that CMS was an efficacious treatment for sepsis in Chinese patients with hematological diseases, while concurrently exhibiting an acceptable toxicity profile. The risk of clinical failure may be predicted by several factors, including a higher APACHEII score, a higher Charlson Comorbidity Index, a history of hematological recurrence or refractoriness, and the use of mechanical ventilation. CMS therapy exhibited good safety, and close monitoring of the renal function is required for patients who have undergone allotransplantation, have aplastic anemia or gastrointestinal infection.