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
. 2025 Mar 20:16:1413563.
doi: 10.3389/fphar.2025.1413563. eCollection 2025.

The efficacy of polymyxin B in treating stroke-associated pneumonia with carbapenem-resistant Gram-negative bacteria infections: a multicenter real-world study using propensity score matching

Hai-Hui Zhuang #  1 , Qi-Hua Chen #  2 , Wei Wang  2 , Qiang Qu  3 , Wei-Xin Xu  1 , Qin Hu  3 , Xiao-Li Wu  4 , Ying Chen  5 , Qing Wan  6 , Tian-Tian Xu  6 , Wen-Ming Long  7 , Yue Luo  8 , Hai-Nan Zhang  2 , Jian Qu  1   9
Affiliations

The efficacy of polymyxin B in treating stroke-associated pneumonia with carbapenem-resistant Gram-negative bacteria infections: a multicenter real-world study using propensity score matching

Hai-Hui Zhuang et al. Front Pharmacol. .

Abstract

Objectives: Infection with Carbapenem-resistant Gram-negative bacteria (CR-GNB) poses further challenges in treating stroke-associated pneumonia (SAP) patients. This multicenter retrospective study aimed to evaluate the efficacy of polymyxin B (PMB) in CR-GNB-infected SAP patients and to identify factors that may influence its effectiveness.

Methods: From 1 September 2019, and 30 December 2022, a total of 196 CR-GNB-infected SAP patients from five hospitals in China were included in the study based on specific criteria. Demographics and clinical data were obtained from the electronic medical records. Propensity score matching (PSM) was used to minimize the effect of potential confounding variables. Univariate analysis and multivariate logistic analysis were performed to identify risk factors affecting microbial efficacy.

Results: Among the 196 SAP patients infected with CR-GNB, 24.5% received PMB combined inhalation and 75.5% received non-combined inhalation treatment. The clinical success rate was 68.9%, with 25.5% achieving microbial efficacy within 7 days and 37.8% achieving microbial cure. The 30-day all-cause mortality rate was 14.8%. The incidence of acute kidney injury was 34.7%. After adjustment by propensity score matching, the PMB combined inhalation group exhibited significantly higher microbial efficacy compared to the non-combined inhalation group (46.7% vs. 26.7%, p = 0.049). Multivariate logistic analysis identified multi-site infections and Carbapenem-resistant Pseudomonas aeruginosa infection as independent risk factors for microbial efficacy.

Conclusion: Combined inhalation of PMB demonstrated superior effectiveness in microbial clearance compared to non-combined inhalation in treating CR-GNB-infected SAP patients. We recommend aerosol combined inhalation of PMB and suggest developing personalized PMB-based regimens for individual patients to enhance treatment outcomes.

Keywords: carbapenem-resistant gram-negative bacteria; clinical efficacy; microbial efficacy; polymyxin B; stroke-associated pneumonia.

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
The flowchart of the patients included in the study.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ali A. N., Howe J., Majid A., Redgrave J., Pownall S., Abdelhafiz A. H. (2018). The economic cost of stroke-associated pneumonia in a UK setting. Top. Stroke Rehabil. 25 (3), 214–223. 10.1080/10749357.2017.1398482 - DOI - PubMed
    1. Amaya-Villar R., Garnacho-Montero J. (2019). How should we treat acinetobacter pneumonia? Curr. Opin. Crit. Care 25 (5), 465–472. 10.1097/mcc.0000000000000649 - DOI - PubMed
    1. Badve M. S., Zhou Z., van de Beek D., Anderson C. S., Hackett M. L. (2019). Frequency of post-stroke pneumonia: systematic review and meta-analysis of observational studies. Int. J. Stroke 14 (2), 125–136. 10.1177/1747493018806196 - DOI - PubMed
    1. Bellomo R., Ronco C., Kellum J. A., Mehta R. L., Palevsky P., Acute Dialysis Quality Initiative w. (2004). Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit. Care 8 (4), R204–R212. 10.1186/cc2872 - DOI - PMC - PubMed
    1. Chen X., Xu J., Zhu Q., Ren Y., Zhao L. (2020). Polymyxin B resistance rates in carbapenem-resistant Pseudomonas aeruginosa isolates and a comparison between Etest(®) and broth microdilution methods of antimicrobial susceptibility testing. Exp. Ther. Med. 20 (2), 762–769. 10.3892/etm.2020.8777 - DOI - PMC - PubMed

LinkOut - more resources