The relationship between the alveolar epithelial lining fluid concentration of intravenous plus inhaled polymyxin B and clinical efficacy in patients with pneumonia caused by carbapenem-resistant gram-negative bacilli: a prospective cohort study
Abstract
Nebulization combined with intravenous polymyxin B (PMB) for carbapenem-resistant gram-negative bacilli (CRGNB) pneumonia still has a number of failures that may be related to insufficient alveolar epithelial lining fluid (ELF) concentration of PMB. This study aimed at determining the relationship between the alveolar ELF concentration of PMB and clinical efficacy after intravenous (IV) plus inhaled (IH) PMB. Seventy-five patients with pneumonia caused by CRGNB were treated with IH plus IV PMB. Alveolar lavage fluid was collected before and after nebulization, and ELF was calculated according to the urea dilution equation. Differences in clinical outcomes between patients with high and low peak and trough concentrations of ELF concentration of PMB were compared separately according to the ROC curve grouping strategy. The primary outcome was favorable clinical outcome. The secondary outcomes included microbiological outcome and time to bacterial eradication, time to renormalize body temperature, CRGNB-related and all-cause mortality, 28-day survival, length of hospitalization, inflammation marker levels and side effects related to PMB. Clinical efficacy and bacterial clearance were higher in the high ELF peak concentration group than in the low one (total efficacy: 94.44% vs. 48.72%, total bacterial clearance: 63.89% vs. 38.46%, both P < 0.05). The clinical effective rate was higher in the high ELF trough concentration group than in the low one (88.89% vs. 43.33%, P < 0.05).…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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