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. 2021 May 28:14:1979-1988.
doi: 10.2147/IDR.S312708. eCollection 2021.

Clinical Efficacy of Polymyxin B in Patients Infected with Carbapenem-Resistant Organisms

Qiong Lu #  1 , Guo-Hua Li #  1 , Qiang Qu  2 , Hai-Hong Zhu  1 , Yue Luo  3 , Han Yan  1 , Hai-Yan Yuan  1 , Jian Qu  1
Affiliations

Clinical Efficacy of Polymyxin B in Patients Infected with Carbapenem-Resistant Organisms

Qiong Lu et al. Infect Drug Resist. .

Abstract

Purpose: Carbapenem-resistant organisms (CROs) pose great challenges for clinical treatment. Polymyxin B (PMB) is one of the "last resort" choices of CRO infections. We explored the possible factors affecting PMB efficacy.

Patients and methods: This retrospective study involved CRO-infected patients treated with PMB for ≥72 h. The endpoint indicator was clinical efficacy. We compared the characteristics (demographics, pathogenic bacteria, PMB treatment) between patients who had "clinical success" (CS) and "clinical failure" (CF).

Results: A total of 191 patients were enrolled: 110 in the CS group and 81 in the CF group. The total cumulative dose for the CS group was higher than the CF group [1100 (700-1443.75) vs 800 (500-1112.5) mg; P = 0.001]. Treatment duration in the CS group was longer than the CF group [11 (8-14) vs 8 (6-11) days; P < 0.000]. Multivariate logistic regression analysis showed mechanical ventilation, vasoactive agents, multiple-site infection, and total cumulative dose to be independently associated with clinical efficacy. Cox survival analysis for 30-day mortality also showed that the use of vasoactive agents and the total cumulative dose of PMB could influence survival time and mortality rate independently.

Conclusion: PMB had good efficacy and a low prevalence of adverse reactions. The total cumulative dose, duration of PMB treatment, mechanical ventilation, vasoactive agents, and multiple-site infection were factors associated with the clinical efficacy of PMB.

Keywords: adverse effect; carbapenem-resistant organisms; clinical efficacy; cumulative dose; polymyxin B.

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Conflict of interest statement

All authors report no conflicts of interest relevant to this article.

Figures

Figure 1
Figure 1
Prevalence of clinical success versus treatment duration and total cumulative dose (Mantel–Haenszel chi-square test).
Figure 2
Figure 2
(A). Cox-regression survival analysis of cumulative dose for 30-day mortality. About half of the patients have a total cumulative dose of more than 1000 mg, defined as high cumulative dose. (B). Cox-regression survival analysis of vasoactive agents for 30-day mortality.
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