Infection and Drug Resistance (Jun 2023)
The Efficacy and Influencing Factors of Polymyxin B in High-Level Carbapenem-Resistant Klebsiella pneumoniae Infections
Abstract
Xuedong Jia,1,2 Zhao Yin,1,2 Wan Zhang,1,2 Shuzhang Du1,2 1Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People’s Republic of China; 2The Precision Clinical Pharmacy Key Laboratory of Henan Province, Zhengzhou, People’s Republic of ChinaCorrespondence: Xuedong Jia; Shuzhang Du, Department of Pharmacy, The First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe Dong Road, ErQi District, Zhengzhou, Henan, 450052, People’s Republic of China, Email [email protected]; [email protected]: Polymyxin B (PMB) is a remedial treatment for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection; however, there is a paucity of reports on the treatment of high-level CRKP infections with polymyxin B. Studies are needed to explore its treatment efficacy and associated influencing factors.Methods: Patients with high-level CRKP infections treated with PMB during hospitalization from June 2019 to June 2021 in a hospital were retrospectively studied, and risk factors affecting the efficacy were explored by subgroup analysis.Results: A total of 92 patients were enrolled, and the results showed that the PMB-based regimen had a bacterial clearance rate of 45.7%, an all-cause discharge mortality rate of 22.8%, and an incidence of acute kidney injury (AKI) of 27.2% for high-level CRKP treatment. The combination of β-lactams other than carbapenems facilitated bacterial clearance, and the combination of electrolyte disturbances and higher APACHE II scores was detrimental to microbial clearance. Risk factors for all-cause discharge mortality were advanced age, concomitant antifungal drugs, concomitant tigecycline and incidence of AKI.Conclusion: PMB-based regimens are an effective option for the treatment of high-level CRKP infections. However, the optimal dose of treatment and the choice of combination regimens need to be explored in further studies.Keywords: efficacy, influencing factors, polymyxin B, carbapenem-resistant Klebsiella pneumoniae
