Analysis of Serum Concentration Monitoring and Influencing Factors of Efficacy of Polymyxin B in the Treatment of Severe Carbapenem-Resistant Gram-Negative Bacterial Pneumonia in Elderly Patients
Objective To investigate the serum concentration monitoring and clinical efficacy of polymyxin B in the treatment of severe carbapenem-resistant organisms(CRO)pneumonia in elderly patients,and to analyze the influencing factors of clinical efficacy.Methods A retrospective analysis was conducted on 45 elderly patients with CRO pneumonia who received intravenous polymyxin B in the ICU of Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2021 to February 2024.According to the"Guidelines for Clinical Trials of Antimicrobial Drugs,"the patients were divided into an effective group and an ineffective group based on the evaluation of antimicrobial treatment efficacy.The serum concentrations of polymyxin B during treatment were compared between the two groups,and univariate analysis of variance and binary logistic regression analysis were used to analyze the influencing factors of clinical efficacy of polymyxin B in elderly patients with severe CRO pneumonia.Results Among the 45 patients,25 were in the effective group(55.56%)and 20 were in the ineffective group(44.44%).The effective group had higher steady-state 24-hour area under the concentration-time curve(AUCss,24 h),average plasma concentration at steady-state(Css,avg),and AUCss,24 h target attainment rate than the ineffective group,with statistically significant differences(P＜0.05).Univariate analysis showed statistically significant differences between the two groups in terms of the presence of acute respiratory distress syndrome(ARDS),duration of medication,use of vasoactive drugs,AUCss,24 h target attainment,pathogen clearance,Acute Physiology and Chronic Health Evaluation II(APACHE II)score,procalcitonin(PCT),and C-reactive protein(CRP)levels(P＜0.05).Binary logistic regression analysis showed that AUCss,24 h target attainment and pathogen clearance were independently associated with good efficacy,while the presence of ARDS,high APACHE II score,use of vasoactive drugs,medication duration＜7 days,and high CRP levels were factors associated with poor efficacy,with statistically significant differences(P＜0.05).Conclusion Therapeutic drug monitoring(TDM)is necessary during the treatment with polymyxin B.AUCss,24 h target attainment and pathogen clearance are independently associated with good efficacy,while the presence of ARDS,high APACHE II score,use of vasoactive drugs,medication duration＜7 days,and high CRP levels are factors associated with poor efficacy in the treatment of severe CRO pneumonia in elderly patients with polymyxin B,which should be given clinical attention.
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