Efficacy and Safety Factors Related to Plasma Concentration-Optimized Polymyxin B Therapy in Treating Carbapenem-Resistant Gram-Negative Bacterial Infections in China.
Infect Drug Resist
; 17: 3057-3071, 2024.
Article
en En
| MEDLINE
| ID: mdl-39050834
ABSTRACT
Background:
Polymyxin B (PMB)-based combination therapies are used to treat severe carbapenem-resistant gram-negative bacterial (CR-GNB) infections. This observational study investigated the relationship between clinical factors, including PMB concentration, and clinical efficacy and safety. Patients andMethods:
Polymyxin B regimens were optimized through therapeutic drug monitoring (TDM) and area under the concentration-time curve (AUC). In all, 382 samples were tested from 130 patients. Logistic regression was used to analyze the relationships between variables with clinical efficacy and 30-day mortality factors were analyzed by Cox regression. The sensitivity and specificity of Cmin and AUC for the occurrence of acute kidney injury (AKI) were determined by ROC curve analysis.Results:
The clinical effectiveness of PMB was 65.4%. Multivariate logistic regression analysis revealed that lung infection, continuous renal replacement therapy, and C-reactive protein were independent factors significantly associated with efficacy. AKI occurred in 14.6% of the patients during treatment; age > 73 years (OR 3.63; 95% CI 1.035-12.727; P = 0.044), Cmin greater than 2.3 µg/mL (OR 7.37; 95% CI 1.571-34.580; P = 0.011), combined vancomycin (OR 9.47; 95% CI 1.732-51.731; P = 0.009), and combined piperacillin-tazobactam (OR 21.87; 95% CI 3.139-152.324; P = 0.002) were independent risk factors. The identified PMB cut-offs for predicting AKI were Cmin = 2.3 µg/mL and AUC = 82.0 mg h/L.Conclusion:
Polymyxin B-based combination regimens are effective in treating CR-GNB infections, particularly bloodstream infections, but have shown unsatisfactory for lung infections. Cmin ≥ 2.3 µg /mL and AUC ≥ 82.0 mg h/L may increase PMB-associated AKI incidence. PMB dose should be adjusted based on TDM to ensure efficacy.
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Colección:
01-internacional
Banco de datos:
MEDLINE
Idioma:
En
Revista:
Infect Drug Resist
Año:
2024
Tipo del documento:
Article