{"title":"多粘菌素B治疗卒中相关性肺炎伴碳青霉烯耐药革兰氏阴性菌感染的疗效：一项使用倾向评分匹配的多中心真实世界研究","authors":"Hai-Hui Zhuang, Qi-Hua Chen, Wei Wang, Qiang Qu, Wei-Xin Xu, Qin Hu, Xiao-Li Wu, Ying Chen, Qing Wan, Tian-Tian Xu, Wen-Ming Long, Yue Luo, Hai-Nan Zhang, Jian Qu","doi":"10.3389/fphar.2025.1413563","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Infection with Carbapenem-resistant Gram-negative bacteria (CR-GNB) poses further challenges in treating stroke-associated pneumonia (SAP) patients. This multicenter retrospective study aimed to evaluate the efficacy of polymyxin B (PMB) in CR-GNB-infected SAP patients and to identify factors that may influence its effectiveness.</p><p><strong>Methods: </strong>From 1 September 2019, and 30 December 2022, a total of 196 CR-GNB-infected SAP patients from five hospitals in China were included in the study based on specific criteria. Demographics and clinical data were obtained from the electronic medical records. Propensity score matching (PSM) was used to minimize the effect of potential confounding variables. Univariate analysis and multivariate logistic analysis were performed to identify risk factors affecting microbial efficacy.</p><p><strong>Results: </strong>Among the 196 SAP patients infected with CR-GNB, 24.5% received PMB combined inhalation and 75.5% received non-combined inhalation treatment. The clinical success rate was 68.9%, with 25.5% achieving microbial efficacy within 7 days and 37.8% achieving microbial cure. The 30-day all-cause mortality rate was 14.8%. The incidence of acute kidney injury was 34.7%. After adjustment by propensity score matching, the PMB combined inhalation group exhibited significantly higher microbial efficacy compared to the non-combined inhalation group (46.7% vs. 26.7%, p = 0.049). Multivariate logistic analysis identified multi-site infections and Carbapenem-resistant <i>Pseudomonas aeruginosa</i> infection as independent risk factors for microbial efficacy.</p><p><strong>Conclusion: </strong>Combined inhalation of PMB demonstrated superior effectiveness in microbial clearance compared to non-combined inhalation in treating CR-GNB-infected SAP patients. We recommend aerosol combined inhalation of PMB and suggest developing personalized PMB-based regimens for individual patients to enhance treatment outcomes.</p>","PeriodicalId":12491,"journal":{"name":"Frontiers in Pharmacology","volume":"16 ","pages":"1413563"},"PeriodicalIF":4.4000,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965127/pdf/","citationCount":"0","resultStr":"{\"title\":\"The efficacy of polymyxin B in treating stroke-associated pneumonia with carbapenem-resistant Gram-negative bacteria infections: a multicenter real-world study using propensity score matching.\",\"authors\":\"Hai-Hui Zhuang, Qi-Hua Chen, Wei Wang, Qiang Qu, Wei-Xin Xu, Qin Hu, Xiao-Li Wu, Ying Chen, Qing Wan, Tian-Tian Xu, Wen-Ming Long, Yue Luo, Hai-Nan Zhang, Jian Qu\",\"doi\":\"10.3389/fphar.2025.1413563\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Infection with Carbapenem-resistant Gram-negative bacteria (CR-GNB) poses further challenges in treating stroke-associated pneumonia (SAP) patients. This multicenter retrospective study aimed to evaluate the efficacy of polymyxin B (PMB) in CR-GNB-infected SAP patients and to identify factors that may influence its effectiveness.</p><p><strong>Methods: </strong>From 1 September 2019, and 30 December 2022, a total of 196 CR-GNB-infected SAP patients from five hospitals in China were included in the study based on specific criteria. Demographics and clinical data were obtained from the electronic medical records. Propensity score matching (PSM) was used to minimize the effect of potential confounding variables. Univariate analysis and multivariate logistic analysis were performed to identify risk factors affecting microbial efficacy.</p><p><strong>Results: </strong>Among the 196 SAP patients infected with CR-GNB, 24.5% received PMB combined inhalation and 75.5% received non-combined inhalation treatment. The clinical success rate was 68.9%, with 25.5% achieving microbial efficacy within 7 days and 37.8% achieving microbial cure. The 30-day all-cause mortality rate was 14.8%. The incidence of acute kidney injury was 34.7%. After adjustment by propensity score matching, the PMB combined inhalation group exhibited significantly higher microbial efficacy compared to the non-combined inhalation group (46.7% vs. 26.7%, p = 0.049). Multivariate logistic analysis identified multi-site infections and Carbapenem-resistant <i>Pseudomonas aeruginosa</i> infection as independent risk factors for microbial efficacy.</p><p><strong>Conclusion: </strong>Combined inhalation of PMB demonstrated superior effectiveness in microbial clearance compared to non-combined inhalation in treating CR-GNB-infected SAP patients. We recommend aerosol combined inhalation of PMB and suggest developing personalized PMB-based regimens for individual patients to enhance treatment outcomes.</p>\",\"PeriodicalId\":12491,\"journal\":{\"name\":\"Frontiers in Pharmacology\",\"volume\":\"16 \",\"pages\":\"1413563\"},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2025-03-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965127/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Pharmacology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fphar.2025.1413563\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"PHARMACOLOGY & PHARMACY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Pharmacology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fphar.2025.1413563","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
The efficacy of polymyxin B in treating stroke-associated pneumonia with carbapenem-resistant Gram-negative bacteria infections: a multicenter real-world study using propensity score matching.
Objectives: Infection with Carbapenem-resistant Gram-negative bacteria (CR-GNB) poses further challenges in treating stroke-associated pneumonia (SAP) patients. This multicenter retrospective study aimed to evaluate the efficacy of polymyxin B (PMB) in CR-GNB-infected SAP patients and to identify factors that may influence its effectiveness.
Methods: From 1 September 2019, and 30 December 2022, a total of 196 CR-GNB-infected SAP patients from five hospitals in China were included in the study based on specific criteria. Demographics and clinical data were obtained from the electronic medical records. Propensity score matching (PSM) was used to minimize the effect of potential confounding variables. Univariate analysis and multivariate logistic analysis were performed to identify risk factors affecting microbial efficacy.
Results: Among the 196 SAP patients infected with CR-GNB, 24.5% received PMB combined inhalation and 75.5% received non-combined inhalation treatment. The clinical success rate was 68.9%, with 25.5% achieving microbial efficacy within 7 days and 37.8% achieving microbial cure. The 30-day all-cause mortality rate was 14.8%. The incidence of acute kidney injury was 34.7%. After adjustment by propensity score matching, the PMB combined inhalation group exhibited significantly higher microbial efficacy compared to the non-combined inhalation group (46.7% vs. 26.7%, p = 0.049). Multivariate logistic analysis identified multi-site infections and Carbapenem-resistant Pseudomonas aeruginosa infection as independent risk factors for microbial efficacy.
Conclusion: Combined inhalation of PMB demonstrated superior effectiveness in microbial clearance compared to non-combined inhalation in treating CR-GNB-infected SAP patients. We recommend aerosol combined inhalation of PMB and suggest developing personalized PMB-based regimens for individual patients to enhance treatment outcomes.
期刊介绍：
Frontiers in Pharmacology is a leading journal in its field, publishing rigorously peer-reviewed research across disciplines, including basic and clinical pharmacology, medicinal chemistry, pharmacy and toxicology. Field Chief Editor Heike Wulff at UC Davis is supported by an outstanding Editorial Board of international researchers. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
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