https://doi.org/10.4081/ecj.2025.13468
A series of clinical cases highlighting cardiotoxicity induced by polymyxin B
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Published: 29 April 2025
Polymyxins, particularly polymyxin B, have resurfaced as critical agents against Multidrug-Resistant Organisms (MDROs) despite their historical withdrawal from clinical use due to significant nephrotoxicity and neurotoxicity. This resurgence is largely driven by the increasing prevalence of infections caused by Carbapenem-Resistant Enterobacterales (CRE) and Carbapenem-Resistant Acinetobacter Baumannii (CRAB). In this report, three clinical cases highlighting the association between polymyxin B administration and severe cardiac events, including ventricular tachycardia and cardiac arrest in patients with multiple co morbidities. The cardio toxic effects of polymyxins are attributed to their impact on cardiac myocyte ionic channels, particularly potassium channels, leading to arrhythmias and potential cardiovascular collapse. Given the rising use of polymyxins amidst escalating resistance patterns, it is imperative for clinicians to recognize and monitor for cardio toxicity, ensuring prompt intervention to mitigate risks associated with this potent antibiotic.
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Berie MB, King MS, Thomsen IP. Polymyxin B infusion leading to cardiac arrest: a case report and literature review. Infection 2015;43:121-4. DOI: https://doi.org/10.1007/s15010-014-0704-3
Biswas S, Brunel JM, Dubus JC, et al. Colistin: an update on the antibiotic of the 21st century. Expert Rev Anti Infect Ther 2012;10:917-934. DOI: https://doi.org/10.1586/eri.12.78
Nation RL, Li J. Colistin in the 21st century. Curr Opin Infect Dis 2009;22:535-43. DOI: https://doi.org/10.1097/QCO.0b013e328332e672
Wang JL, Xiang BX, Song XL, et al. Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients: A meta-analysis. World J Clin Cases 2022;10:11466-85. DOI: https://doi.org/10.12998/wjcc.v10.i31.11466
Abdelraouf K, Braggs KH, Yin T, et al. Characterization of polymyxin B-induced nephrotoxicity: implications for dosing regimen design. Antimicrob Agents Chemother 2012;56:4625-9. DOI: https://doi.org/10.1128/AAC.00280-12
Falagas ME, Kasiakou SK. Toxicity of polymyxins: a systematic review of the evidence from old and recent studies. Crit Care 2006;10:R27. DOI: https://doi.org/10.1186/cc3995
Naesens R, Janssens H, Lenaerts F, et al. Tolerability of high-dose (3 million units loading and 9 million units maintenance) intravenous colistin in critically ill patients. J Antimicrob Chemother 2010;65:1836-7.
Wunsch H, Moitra VK, Patel M, Dzierba AL. Polymyxin use associated with respiratory arrest. Chest 2012;141:515–7. DOI: https://doi.org/10.1378/chest.11-1483
Lindesmith LA, Baines RD Jr, Bigelow DB, Petty TL. Reversible respiratory paralysis associated with polymyxin therapy. Ann Intern Med 1968;68:318–27. DOI: https://doi.org/10.7326/0003-4819-68-2-318
Adams MD, Nickel GC, Bajaksouzian S, et al. Resistance to colistin in Acinetobacter baumannii associated with mutations in the PmrAB two-component system. Antimicrob Agents Chemother 2009;53:3628-34. DOI: https://doi.org/10.1128/AAC.00284-09
Zavascki AP, Goldani LZ, Li J, Nation RL. polymyxin B for the treatment of multidrug-resistant pathogens: a critical review. J Antimicrob Chemother 2007;60:1206-15. DOI: https://doi.org/10.1093/jac/dkm357
Falagas ME, Kasiakou SK, Kofteridis DP, et al. Effectiveness and nephrotoxicity of intravenous colistin for treatment of patients with infections due to polymyxin-only-susceptible (POS) gram-negative bacteria. Eur J Clin Microbiol Infect Dis 2006;25:596-9. DOI: https://doi.org/10.1007/s10096-006-0191-2
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