Optimizing Polymyxin B Exposure in Carbapenem-Resistant Organism-Associated Hospital-Acquired Pneumonia: A Retrospective Observational Study.
- 1Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
- 2Department of Pharmacy, Zhongda Hospital, Southeast University, School of Medicine, Southeast University, Nanjing, 210009, People's Republic of China.
Abstract
Background
The area under the 24-hour concentration-time curve (AUC0-24h) is a key pharmacokinetic parameter for polymyxin B (PMB), but the optimal exposure target in critically ill patients remains uncertain.Objective
This study aimed to investigate the relationship between PMB AUC0-24h and clinical efficacy in patients with carbapenem-resistant hospital-acquired pneumonia (HAP), and to identify the optimal therapeutic AUC0-24h range for PMB.Methods
This retrospective observational study included patients with carbapenem-resistant HAP who received intravenous PMB and therapeutic drug monitoring. Plasma PMB concentrations were measured by validated ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The primary outcome was 14-day clinical treatment success, and the secondary outcome included acute kidney injury (AKI). Logistic regression and restricted cubic spline analyses were used to assess exposure-outcome relationships.Results
A total of 138 patients were included, the median age was 68 years, and 110 (79.7%) were male. Clinical success was achieved in 63 (45.7%) patients. Carbapenem-resistant Acinetobacter baumannii accounted for 77.5% of infections. The median AUC0-24h of PMB was 77.5 (55.6, 105.6) mg·h/L. An AUC0-24h > 77 mg·h/L enabled to predict the clinical treatment success, while AUC0-24h > 110 mg·h/L enabled to predict the AKI incidence. In multivariable analysis, AUC0-24h < 77 mg·h/L was an independent risk factor for reduced clinical treatment success (OR: 0.33, 95% CI: 0.13-0.78; p = 0.013), while AUC0-24h > 110 mg·h/L significantly increased AKI risk (OR: 3.24, 95% CI: 1.06-10.47; p = 0.043).Conclusion
The AUC0-24h of PMB is closely associated with both 14-day clinical treatment success rates and the incidence of AKI in patients with carbapenem-resistant HAP, with an optimal range from 77 to 110 mg·h/L.
Related
- Efficacy of polymyxin B against different pathogens in carbapenem-resistant gram-negative bacterial pneumonia and its relationship with alveolar epithelial lining fluid concentration: a prospective cohort study
- Factors associated with actual mode of delivery among women attending antenatal education at a university hospital in Türkiye: a retrospective observational study
- Factors Associated with Delayed Consultation for Anorectal Symptoms in Women: A Retrospective Observational Study.
- Early Postoperative Nausea and Vomiting in Routine Clinical Practice: A Retrospective Observational Study of Associated Perioperative Factors and Prophylactic Practices.
- Efficacy and safety of combined intraventricular/intrathecal and intravenous polymyxin B for postsurgical neurosurgical infections due to MDR/XDR-GNB: a retrospective cohort study.
BibTeX
@article{xiong2026optimizing,
title = {{Optimizing Polymyxin B Exposure in Carbapenem-Resistant Organism-Associated Hospital-Acquired Pneumonia: A Retrospective Observational Study.}},
author = {Mengru Xiong and Xiaoting Xu and Linlin Hu and Jie He and Hui Chen and Wenhan Hu and Qingyun Peng and Mingze Bi and Shijia Zhong and Haofei Wang and Shuhe Yang and Jianfeng Xie and Yingzi Huang},
journal = {Drug design, development and therapy},
year = {2026},
month = oct,
doi = {10.2147/dddt.s646556},
url = {https://europepmc.org/article/MED/42968961},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Optimizing Polymyxin B Exposure in Carbapenem-Resistant Organism-Associated Hospital-Acquired Pneumonia: A Retrospective Observational Study.
AU - Mengru Xiong
AU - Xiaoting Xu
AU - Linlin Hu
AU - Jie He
AU - Hui Chen
AU - Wenhan Hu
AU - Qingyun Peng
AU - Mingze Bi
AU - Shijia Zhong
AU - Haofei Wang
AU - Shuhe Yang
AU - Jianfeng Xie
AU - Yingzi Huang
PY - 2026
DA - 2026/10/28
JO - Drug design, development and therapy
DO - 10.2147/dddt.s646556
UR - https://europepmc.org/article/MED/42968961
AB - Background The area under the 24-hour concentration-time curve (AUC0-24h) is a key pharmacokinetic parameter for polymyxin B (PMB), but the optimal exposure target in critically ill patients remains uncertain.Objective This study aimed to investigate the relationship between PMB AUC0-24h and clinical efficacy in patients with carbapenem-resistant hospital-acquired pneumonia (HAP), and to identify the optimal therapeutic AUC0-24h range for PMB.Methods This retrospective observational study included patients with carbapenem-resistant HAP who received intravenous PMB and therapeutic drug monitoring. Plasma PMB concentrations were measured by validated ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). The primary outcome was 14-day clinical treatment success, and the secondary outcome included acute kidney injury (AKI). Logistic regression and restricted cubic spline analyses were used to assess exposure-outcome relationships.Results A total of 138 patients were included, the median age was 68 years, and 110 (79.7%) were male. Clinical success was achieved in 63 (45.7%) patients. Carbapenem-resistant Acinetobacter baumannii accounted for 77.5% of infections. The median AUC0-24h of PMB was 77.5 (55.6, 105.6) mg·h/L. An AUC0-24h > 77 mg·h/L enabled to predict the clinical treatment success, while AUC0-24h > 110 mg·h/L enabled to predict the AKI incidence. In multivariable analysis, AUC0-24h < 77 mg·h/L was an independent risk factor for reduced clinical treatment success (OR: 0.33, 95% CI: 0.13-0.78; p = 0.013), while AUC0-24h > 110 mg·h/L significantly increased AKI risk (OR: 3.24, 95% CI: 1.06-10.47; p = 0.043).Conclusion The AUC0-24h of PMB is closely associated with both 14-day clinical treatment success rates and the incidence of AKI in patients with carbapenem-resistant HAP, with an optimal range from 77 to 110 mg·h/L.
SN - 1177-8881
ER -