Clinical Observation Of Colistin Sulfate In The Treatment Of Hematologic Diseases Complicated With Multidrug Resistant Bacteria Infection

Objective:Evaluate the efficacy and safety of colistin sulfat e in the treatment of hematological diseases with multi-drug resistant bacterial infections,and guide its better clinical applicationMethods:From August 2020 to January 2023,patients with hematological diseases complicated with multi-drug resistant bacterial infectio ns were treated with colistin sulfate in the Department of Hematology,Bethune Hospital,Shanxi Province.The general conditions,clini cal manifestations,laboratory parameters,efficacy and safety indicators of treatment were analyzed.The patients were divided into agranulocytosis group and non-agranulocytosis group according to the presence or absence of agranulocytosis,and the differences in the effective rates between the two groups were evaluated.The days of medication,days of body temperature decr ease of 1℃ or recovery,days of C-reactive protein decrease of 50% or recovery,and days of procalcitonin decrease of 50% or reco very were compared between the two groups.The effects of sex,age,multisite infection,multidrug-resistant bacterial infection,body mass index(BMI),length of hospital stay,agranulocytosis,procalcitonin before treatment,C-reactive protein before treatment,and body temperature before treatment on the efficacy of colistin sulfate were also analyzed.Results:A total of 32 patients with hematological diseases and multi-drug resistant bacterial infections were treated with colistin sulfate,and 22 patients achieved clinical response,with a response rate of 68.8%(22/32),including 68.4%(13/19)in the agranulocytosis group and 69.2%(9/13)in the non-agranulocytosis group,with no significant difference(P > 0.05).There was no significant difference in the days of medication,days of body temperature decrease of 1 ° C or days of recovery,days of C-reactive protein decrease of 50% or days of recovery,and days of procalcitonin decrease of50% or days of recovery between the agranulocytosis group and the non-agranulocytosis group(P > 0.05).Multivariate analysis showed that the factor affecting the efficacy of colistin sulfate was procalcitonin level before treatment.One patient in the non-agranulocytosis group developed nephrotoxicity,with an incidence of 3.1%(1/32).One patient in the agranulocytosis group developed neurotoxicity,with an incidence of 3.1%(1/32).Conclusion:1.The effective rate of colistin sulfate in the treatment of hematological diseases with multi-drug resistant bacterial infections is similar to that reported previously,with a certain effect,and there is no significant difference in the efficacy in p atients with agranulocytosis and non-agranulocytosis.2.The incidence of nephrotoxicity and neurotoxicity is low during colistin sulfate application,and the related damage can be recovered or alleviated after drug withdrawal or symptomatic treatment.3.The influencing factors affecting the efficacy of colistin sulfate are procalcitonin levels before treatment,focusing on procalcitonin levels in patients with high risk of multi-drug resistant bacterial infections such as hematological diseases,and early m edication,which can effectively improve the effective rate of colistin sulfate.