Objective To evaluate the clinical effects and safety of polymyxin B on ventilator-associated pneumonia caused by pandrug-resistant Acinetobacter baumannii (PDR-AB) in patients with chronic obstructive pulmonary disease (COPD). Methods COPD patients who were diagnosed as ventilator-associated pneumonia caused by PDR-AB and treated with polymyxin B between January 2015 and August 2016 in this hospital were included in this retrospective study. The patients’ symptoms, vital signs, and the results of laboratory examinations were recorded before and after treatment. The clinical cure rates, microbiological eradication rates, mortality and safety were also measured. Results A total of 11 cases were included in this study. Mean time of therapy was 10 days, ranged 8-13 days. After treatment with polymyxin B, most of the patients’ clinical symptoms, signs, and results of laboratory tests as well as imaging examinations were significantly improved. Seven cases had clinical response, and the clinical efficacy rate was 63.6%; 8 cases achieved bacteriological eradication, with the bacteriological eradication rate of 72.7%. Four patients died, and the overall mortality was 36.4%. Only 1 case discontinued treatment with polymyxin B because of the drug fever. Conclusions Polymyxin B might be an alternative option for COPD patients with ventilator-associated pneumonia caused by PDR-AB, who is non-responder to prior antimicrobial therapy. However, this method should be evaluated cautiously in prospective well-controlled studies.
ObjectiveTo investigate the effect of polymyxin B hemoperfusion on the prognosis of patients with sepsis and septic shock by meta-analysis.MethodsSupplemented by manual search and document traceability, the US National Library of Medicine Pubmed, the Dutch Medical Abstracts Embase database, and the Cochrane clinical trial database were searched. Randomized controlled trials (RCTs) were collected from January 1998 to October 2018 for the treatment of sepsis and septic shock with polymyxin B hemoperfusion, only limited to English publications. The collected RCTs were evaluated and the prognosis of patients with sepsis and septic shock was analyzed by the Cochrane Collaboration.ResultsFinally six RCTs were included, and a total of 926 patients were analyzed, with 471 patients in the polymyxin B hemoperfusion group and 455 patients in the control group. The mortality rate was 36.3% (171/471) in the polymyxin B hemoperfusion group and 39.1% (178/455) in the control group. Hemoperfusion with polymyxin B could not reduce the patient mortality (RR=0.80, 95% CI 0.56 to 1.15, P=0.233). A subgroup analysis was taken on the patients with moderate to severe septic shock. Four RCTs were included in total and 418 patients were analyzed, with 207 patients in the polymyxin B hemoperfusion group and 211 in the control group. The mortality rate was 38.65% (80/207) in the polymyxin B hemoperfusion group and 50.71% (107/211) in the control group were. The hemoperfusion of polymyxin B could significantly reduce the mortality of patients with moderate to severe septic shock (RR=0.70, 95% CI 0.52 to 0.96, P=0.025).ConclusionsOlymyxin B hemoperfusion can not improve the prognosis of patients with sepsis and septic shock. However, compared with conventional treatment, polymyxin B hemoperfusion can improve the 28-day mortality rate of patients of severe septic shock. Due to the limit number of randomized controlled trials, more high-quality trials are needed to a further confirmation.
Objective To compare the clinical efficacy of intravenous polymyxin B alone and intravenous drip combined with nebulized inhaled polymyxin B in treatment of patients with carbapenem-resistant organism (CRO) pneumonia. Methods The clinical data of 85 patients with CRO pneumonia admitted to the Intensive Care Unit of Nanjing Drum Tower Hospital from September 2020 to June 2023 were collected using a retrospective study. According to the different ways of administration of polymyxin B, the patients receiving polymyxin B intravenous drip therapy alone were included in group A, and the patients receiving polymyxin B intravenous drip therapy combined with nebulized inhalation therapy were included in group B. The therapeutic effective rate, bacterial clearance rate, 30-day all-cause mortality and the level of infection indexes before and after the use of medication were compared between the two groups. The occurrence of acute kidney injury during the use of drugs in the two groups was observed and recorded. Results The pathogenicity culture results showed that there was no statistically significant difference between the two groups (P=0.144). Serum procalcitonin and C-reactive protein were significantly lower in the two groups after drug administration compared with those before drug administration (both P<0.05). The therapeutic efficiency and bacterial clearance rate in group B were higher than those in group A (both P<0.05). There was no statistically significant difference in 30-day all-cause mortality between the two groups (P=0.664). And there was no statistically significant difference in the incidence of adverse reactions between the two groups (P=0.650). Conclusion When polymyxin B is used to treat patients with CRO pneumonia, the intravenous drip combined with nebulized inhalation regimen is superior to intravenous drip therapy alone and does not increase the risk of developing nephrotoxicity.