Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 May 28:11:1400757.
doi: 10.3389/fmed.2024.1400757. eCollection 2024.

Efficiency of polymyxin B treatment against nosocomial infection: a systematic review and meta-analysis

Liyuan Peng #  1 , Zhongheng Zhang #  2 , Xueyan Qi  3 , Yanjun Zhong  4 , Tongwen Sun  3 , Lvlin Chen  1 , Junchen Zhu  1 , Xiangui Lv  1 , Penglin Ma  5
Affiliations

Efficiency of polymyxin B treatment against nosocomial infection: a systematic review and meta-analysis

Liyuan Peng et al. Front Med (Lausanne). .

Abstract

Background: Some cohort studies have explored the effects and safety of polymyxin B (PMB) in comparison to other antibiotics for the treatment of nosocomial infections, yielding inconsistent results. This systematic review aims to explore the effectiveness and safety of PMB and compared it with other antibiotics.

Methods: A systematic literature search was conducted in PubMed, Embase, the Cochrane Library, and Web of Science, searching specific terms to identify quantitative cohort studies or RCTs that compared the effects of PMB with other antibiotics in terms of their efficacy and safety. The Newcastle-Ottawa Scale (NOS) was conducted to evaluate the risk of bias of observational studies. Odds ratios with 95% confidence intervals were used for outcome assessment. We evaluated heterogeneity using the I 2 test.

Results: A total of 22 observational trials were included in the analysis. The PMB group had a higher mortality rate compared to the control group (odds ratio: 1.84, 95% CI: 1.36-2.50, p<0.00001, I 2 = 73%). while, the ceftazidime-avibactam group demonstrated a distinct advantage with lower mortality rates, despite still exhibiting high heterogeneity (odds ratio 2.73, 95% confidence interval 1.59-4.69; p = 0.0003; I 2 = 53%). Additionally, the PMB group had a lower nephrotoxicity rate compared to the colistin group but exhibited high heterogeneity in the results (odds ratio 0.58, 95% CI 0.36-0.93; p = 0.02; I 2 = 73%).

Conclusion: In patients with nosocomial infections, PMB is not superior to other antibiotics in terms of mortality, specifically when compared to ceftazidime-avibactam. However, PMB demonstrated an advantage in terms of nephrotoxicity compared to colistin.

Keywords: Polymyxin B; ceftazidime-avibactam; colistin; meta-analysis; nosocomial infections; tigecycline.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Funnel plot of mortality.
Figure 3
Figure 3
The mortality was compared between PMB and other antibiotics.
Figure 4
Figure 4
The mortality was compared between PMB and other antibiotics (subgroup analysis based on the risk of bias).
Figure 5
Figure 5
The mortality was compared between PMB and colistin.
Figure 6
Figure 6
The mortality was compared between PMB and tigecycline.
Figure 7
Figure 7
The mortality was compared between PMB and ceftazidime-avibactam.
Figure 8
Figure 8
The mortality was compared between PMB and ceftazidime-avibactam (low and moderate risk of studies).
Figure 9
Figure 9
The nephrotoxicity was compared between PMB and other antibiotics.
Figure 10
Figure 10
The nephrotoxicity was compared between PMB and other antibiotics (subgroup analysis based on the risk of bias).
Figure 11
Figure 11
The nephrotoxicity was compared between PMB and colistin.
Figure 12
Figure 12
The nephrotoxicity was compared between PMB and tigecycline.
Figure 13
Figure 13
The bacterial clearance rate was compared between PMB and ceftazidime-avibactam.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Gastmeier P. Nosocomial infection surveillance and control policies. Curr Opin Infect Dis. (2004) 17:295–301. doi: 10.1097/01.qco.0000136929.75543.8a - DOI - PubMed
    1. Liu JY, Dickter JK. Nosocomial infections: a history of hospital-acquired infections. Gastrointest Endosc Clin N Am. (2020) 30:637–52. doi: 10.1016/j.giec.2020.06.001 - DOI - PubMed
    1. Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev. (2011) 24:141–73. doi: 10.1128/CMR.00027-10, PMID: - DOI - PMC - PubMed
    1. Trivic I, Hojsak I. Use of probiotics in the prevention of nosocomial infections. J Clin Gastroenterol. (2017) 52:S62–5. doi: 10.1097/MCG.0000000000001070 - DOI - PubMed
    1. Kollef M, Torres A, Shorr A, Martin-Loeches I, Micek S. Nosocomial infection. Crit Care Med. (2021) 49:169–87. doi: 10.1097/ccm.0000000000004783 - DOI - PubMed

LinkOut - more resources