Efficacy and safety of polymyxin B in carbapenem-resistant gram-negative organisms infections

G L Xia,R L Jiang

doi:10.1186/s12879-021-06719-y

Abstract

ObjectiveTo investigate how to use polymyxin B rationally in order to produce the best efficacy and safety in patients with carbapenem-resistant gram-negative organisms (CRO) infection.MethodsThe clinical characteristics and microbiological results of 181 patients caused by CRO infection treated with polymyxin B in the First Affiliated Hospital from July 2018 to May 2020 were retrospectively analyzed. The bacterial clearance rate, clinical efficacy, adverse drug reactions and 28 days mortality were evaluated.ResultsThe overall effective rate of 181 patients was 49.72%, the total bacterial clearance rate was 42.0%, and the 28 day all-cause mortality rate was 59.1%. The effective rate and bacterial clearance rate in the group of less than 24 h from the isolation of CRO to the use of polymyxin B were significantly higher than those in the group of more than 24 h. Logistics multivariate regression analysis showed that the predictive factors for effective treatment of CRO with polymyxin B were APACHEII score, duration of polymyxin B treatment, combination of polymyxin B and other antibiotics, and bacterial clearance. 17 cases (9.36%) of acute kidney injury were considered as polymyxin B nephrotoxicity and 4 cases (23.5%) recovered after polymyxin B withdrawal. After 14 days of polymyxin B use, 3 cases of polymyxin B resistance appeared, and there were 2 cases of polymyxin B resistance in the daily dose 1.5 mg/kg/day group.ConclusionFor CRO infection, the treatment of polymyxin B should be early, combined, optimal dose and duration of treatment, which can achieve better clinical efficacy and microbial reactions, and reduce the adverse reactions and drug resistance.

Highlights

In recent years, with the wide application of broad-spectrum antibiotics in clinic and the poor control of nosocomial infections, the bacterial resistance rate has increased year by year, which has become a serious global problem.In particular, carbapenem-resistant gram negative organisms (CRO) have high resistance to conventional antibiotics, which increases the difficulty of treatment [1, 2]
Carbapenem-resistant gram negative organisms (CRO) have high resistance to conventional antibiotics, which increases the difficulty of treatment [1, 2]
Gram-negative bacteria are the most common pathogens of sepsis, and Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli are the main pathogens in China [4]

Summary

Introduction

Carbapenem-resistant gram negative organisms (CRO) have high resistance to conventional antibiotics, which increases the difficulty of treatment [1, 2]. The toxicity of polymyxin B may be alleviated due to the improvement of preparation quality, which promotes its clinical application [4]. Both domestic and foreign guidelines recommend polymyxin B as an important therapeutic drug for the infection of carbapenemresistant bacterial strains such as carbapenem-resistant. Gram-negative bacteria are the most common pathogens of sepsis, and Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli are the main pathogens in China [4]

Methods

Results

Conclusion