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
ObjectivesInfection 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 fact...
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Frontiers Media S.A.
2025-03-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2025.1413563/full |
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| author | 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 Jian Qu |
| author_facet | 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 Jian Qu |
| author_sort | Hai-Hui Zhuang |
| collection | DOAJ |
| description | ObjectivesInfection 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.MethodsFrom 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.ResultsAmong 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.ConclusionCombined 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. |
| format | Article |
| id | doaj-art-aa2914e69ec04d268779201d3e3b712e |
| institution | Kabale University |
| issn | 1663-9812 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj-art-aa2914e69ec04d268779201d3e3b712e2025-08-20T03:42:30ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-03-011610.3389/fphar.2025.14135631413563The efficacy of polymyxin B in treating stroke-associated pneumonia with carbapenem-resistant Gram-negative bacteria infections: a multicenter real-world study using propensity score matchingHai-Hui Zhuang0Qi-Hua Chen1Wei Wang2Qiang Qu3Wei-Xin Xu4Qin Hu5Xiao-Li Wu6Ying Chen7Qing Wan8Tian-Tian Xu9Wen-Ming Long10Yue Luo11Hai-Nan Zhang12Jian Qu13Jian Qu14Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, ChinaDepartment of Neurology, The Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Neurology, The Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Pharmacy, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, ChinaDepartment of Pharmacy, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Pharmacy, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, ChinaDepartment of Pharmacy, Renmin Hospital, Wuhan University, Wuhan, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of Pharmacy, The First Affiliated Hospital of Nanchang University, Nanchang, ChinaDepartment of Pharmacy, The Second People’s Hospital of Huaihua, Huaihua, ChinaDepartment of Pharmacy, The People’s Hospital of Liuyang, Liuyang, ChinaDepartment of Neurology, The Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, ChinaHunan Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, ChinaObjectivesInfection 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.MethodsFrom 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.ResultsAmong 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.ConclusionCombined 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.https://www.frontiersin.org/articles/10.3389/fphar.2025.1413563/fullstroke-associated pneumoniapolymyxin Bcarbapenem-resistant gram-negative bacteriaclinical efficacymicrobial efficacy |
| spellingShingle | 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 Jian Qu 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 Frontiers in Pharmacology stroke-associated pneumonia polymyxin B carbapenem-resistant gram-negative bacteria clinical efficacy microbial efficacy |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | stroke-associated pneumonia polymyxin B carbapenem-resistant gram-negative bacteria clinical efficacy microbial efficacy |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1413563/full |
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