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Outline
To investigate the relationship between intravenous polymyxin B (PMB) exposure and clinical outcome in septic patients, and to explore the pharmacokinetic target.
This single-center observational study enrolled septic patients who received PMB therapy between July 2021 and July 2025. Primary outcome was the clinical success rate. Secondary outcomes included 28-day all-cause mortality, 90-day survival time, bacterial clearance, 28-day ventilator/ICU/hospital-free days and incidence of PMB-related acute kidney injury (AKI). The AUCss, 0-12 h and Css, avg were analyzed for associations with outcomes, and cut-off value was determined by receiver-operating characteristic (ROC) curves. Subgroup analysis was conducted among patients receiving continuous renal replacement therapy (CRRT).
Of 82 septic patients, clinical success rate was 37.8%. The AUCss, 0-12 h cut-off value was 27.10 mg·h-1·L-1 (Css, avg 2.26 mg·L-1). AUCss, 0-12 h > 27.10 mg·h-1·L-1 was associated with longer 90-day survival time (ETR=1.92, P=0.039). In the CRRT subgroup, increased loading dose was associated with longer 90-day survival time (ETR=1.38, P=0.015). The incidence of PMB-related AKI was 40.54% (15/37).. Patients with AKI had higher AUCss, 0-12 h (43.51 vs. 27.23 mg·h-1·L-1, P=0.006).
PMB exposure is associated with clinical efficacy in septic patients. Maintaining an AUCss, 0-12 h > 27.10 mg·h-1·L-1 (Css, avg of 2.26 mg·L-1) enhances clinical success. Higher AUCss, 0-12 h is an independent risk factor for PMB-related AKI. Therapeutic drug monitoring is recommended to ensure efficacy and safety.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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