Jiang Nanhong, Xie Weiguo, Wang Deyun, Wang Wei
Department of Burns, Tongren Hospital of Wuhan University (Wuhan Third Hospital), Wuhan, China.
Eur J Clin Microbiol Infect Dis. 2025 Jun;44(6):1433-1442. doi: 10.1007/s10096-025-05119-3. Epub 2025 Apr 3.
The prevalence of Carbapenem-Resistant Gram-Negative Bacteria (CR-GNB) is rapidly escalating, presenting a significant global public health concern. This study aims to evaluate the survival rate of early appropriate therapy with polymyxin B (PMB), and adverse drug reactions of PMB in treating severe burn sepsis caused by CR-GNB infections.
We retrospectively analyzed 72 patients with severe burn sepsis caused by CR-GNB infections from January 1, 2018, to December 30, 2023. These patients received a treatment regimen based on PMB for at least three days. We collected data on the patient's clinical characteristics, microbiological results, details of PMB treatment, adverse drug reactions with PMB, and mortality. We compared the 30-day mortality rates between patients who received early appropriate therapy (the timely administration of an active antimicrobial agent within 48 h after the onset of infection) and those who underwent non-early appropriate therapy, multivariate Cox regression analysis was employed to evaluate factors impacting the 30-day survival rate of patients, and the adverse drug reactions caused by PMB were also analyzed.
Among the 72 patients with severe burn sepsis, the clinical effective rate was 69.4% (50/72), the 30-day all-cause mortality rate was 31.9% (23/72) and the 30-day sepsis-associated mortality rate was 27.8% (20/72). The adverse drug reactions of PMB included nephrotoxicity and skin pigmentation, with an incidence of 19.4% (14/72) and 15.3% (11/72), respectively. The patients who received early appropriate therapy had a lower mortality rate, lower SOFA scores and more wound infections compared to those who underwent non-early appropriate therapy (all P < 0.05). The univariate Cox regression analysis showed that age, hypertension, SOFA score at the time of sepsis diagnosis, and early appropriate therapy with PMB were associated with both 30-day all-cause mortality and sepsis-associated mortality in severely burned patients (all P < 0.05). Additionally, In the multivariate Cox regression analysis, early appropriate therapy with PMB was identified as an independent protective factor for both 30-day all-cause mortality (HR = 0.183 [95% CI 0.071-0.468], P < 0.001) and sepsis-associated mortality (HR = 0.150 [95% CI 0.054-0.414], P < 0.001) in severely burned patients.
Polymyxin B is an effective option for burn sepsis patients in treating CR-GNB infections. Early appropriate therapy with PMB significantly improved the survival rate of severe burn sepsis patients infected with CR-GNB.
耐碳青霉烯类革兰氏阴性菌（CR-GNB）的流行率正在迅速上升，这是一个重大的全球公共卫生问题。本研究旨在评估早期使用多粘菌素B（PMB）进行恰当治疗的生存率，以及PMB治疗由CR-GNB感染引起的严重烧伤脓毒症时的药物不良反应。
我们回顾性分析了2018年1月1日至2023年12月30日期间72例由CR-GNB感染引起的严重烧伤脓毒症患者。这些患者接受了基于PMB的治疗方案至少三天。我们收集了患者的临床特征、微生物学结果、PMB治疗细节、PMB的药物不良反应以及死亡率的数据。我们比较了接受早期恰当治疗（在感染发作后48小时内及时给予有效的抗菌药物）的患者和未接受早期恰当治疗的患者的30天死亡率，采用多因素Cox回归分析来评估影响患者30天生存率的因素，并分析了PMB引起的药物不良反应。
在72例严重烧伤脓毒症患者中，临床有效率为69.4%（50/72），30天全因死亡率为31.9%（23/72），30天脓毒症相关死亡率为27.8%（20/72）。PMB的药物不良反应包括肾毒性和皮肤色素沉着，发生率分别为19.4%（14/72）和15.3%（11/72）。与未接受早期恰当治疗的患者相比，接受早期恰当治疗的患者死亡率更低、序贯器官衰竭评估（SOFA）评分更低且伤口感染更多（所有P＜0.05）。单因素Cox回归分析显示，年龄、高血压、脓毒症诊断时的SOFA评分以及早期使用PMB进行恰当治疗与严重烧伤患者的30天全因死亡率和脓毒症相关死亡率均相关（所有P＜0.05）。此外，在多因素Cox回归分析中，早期使用PMB进行恰当治疗被确定为严重烧伤患者30天全因死亡率（风险比[HR]=0.183[95%置信区间（CI）0.071 - 0.468]，P＜0.001）和脓毒症相关死亡率（HR = 0.150[95%CI 0.054 - 0.414]，P＜0.001）的独立保护因素。
多粘菌素B是治疗烧伤脓毒症患者CR-GNB感染的有效选择。早期使用PMB进行恰当治疗显著提高了感染CR-GNB的严重烧伤脓毒症患者的生存率。
