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

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:

• polymyxin B
• carbapenem-resistant organisms
• clinical efficacy
• adverse effect
• cumulative dose

Acknowledgments

We thank the supported grants of the National Scientific Foundation of China (No. 81503166), Hunan Provincial Natural Science Foundation of China (2018JJ3718), WU JIEPING Medical Foundation (320.6750.19090-11), and the Hunan Provincial Department of Finance Grant (No.2019-93, No. 2018-92).

Abbreviations

CROs, carbapenem-resistant organisms; PMB, polymyxin B; CS, clinical success; CF, clinical failure; CREs, enterobacteriaceae-resistant organisms; MIC, minimum inhibitory concentration.

Data Sharing Statement

Available.

Ethics Approval and Informed Consent

The study protocol was approved by the Ethics Committees of the Second Xiangya Hospital of Central South University (LYF-2020021) in Changsha, China. This retrospective study involved patients admitted to the Second Xiangya Hospital of Central South University from 2018 to 2019.

Consent for Publication

Available.

Author Contributions

JQ and QL conceptualized and designed the study. GHL, HHZ, YL and HYY acquired data. GHL, QQ and HY analyzed the data. GHL, HY, JQ, and QL drafted the manuscript. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

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