| 引用本文: | 白亚楠#,朱晨霞#,王融溶,举沅芷,杜永忠,姜赛平.多黏菌素B治疗耐碳青霉烯类革兰阴性杆菌有效性和肾毒性：一项单中心、回顾性、观察性研究[J].中国现代应用药学,2026,43(2):108-113. |
| Yanan Bai#,Chenxia Zhu#,Rongrong Wang,Yuanzhi Ju,Yongzhong Du,Saiping Jiang.Efficacy and nephrotoxicity of polycolistin B for carbapenem-resistant gram-negative bacilli: a single-center, retrospective, observational study[J].Chin J Mod Appl Pharm(中国现代应用药学),2026,43(2):108-113. |
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| 多黏菌素B治疗耐碳青霉烯类革兰阴性杆菌有效性和肾毒性：一项单中心、回顾性、观察性研究 |
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白亚楠#1,2, 朱晨霞#3, 王融溶4, 举沅芷1,2, 杜永忠5, 姜赛平1,2
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1. 浙江大学药学院临床药学研究中心，杭州，310058;2. 浙江大学医学院附属第一医院临床药学部，杭州 310003;3.湖州市中心医院临床药学科;4.浙江大学医学院附属第一医院临床药学部;5.浙江大学药学院临床药学研究中心，杭州，310058
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| 摘要: |
| 目的 中通过分析多黏菌素B（PMB）在治疗耐碳青霉烯类革兰阴性杆菌（CR-GNB）感染有效性及肾毒性，为PMB的合理使用提供科学依据。方法 本研究回顾性纳入了2021年10月至2022年7月期间，经确诊为CR-GNB感染，并首次于我院接受多黏菌素B静脉注射治疗持续至少72小时的成年患者，对患者基线资料、临床疗效以及急性肾损伤（AKI）进行统计分析。结果 353例患者经剔除后共纳入90例，耐碳青霉烯类革兰阴性菌感染多黏菌素B（PMB）治疗细菌清除率为30.9%（21/68），28 d死亡率为36.4%（32/88），AKI总发生率为36.2%（25/69）。亚组分析提示ICU组PMB治疗细菌清除率（33.3% vs 25.0%）、28 d死亡率（41.4% vs 26.7%）和AKI发生率（44.2% vs 23.1%）在数值上呈现高于非ICU组的趋势，但未达统计学差异（P＞0.05）。PMB治疗在ICU组主要用于耐碳青霉烯类耐药鲍曼不动杆菌和肺部感染。多因素logistic回归分析显示患者治疗前C反应蛋白水平和接受肾脏替代疗法是PMB治疗期间28 d死亡率的独立危险因素。结论 多黏菌素B在根除CR-GNB感染病原体方面效果有限但在临床治疗中仍显示出一定的疗效，用药过程需严密监测PMB潜在的肾毒性。 |
| 关键词: 多黏菌素 B 耐碳青霉烯类革兰阴性杆菌 有效性 肾毒性 |
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| 基金项目:浙江省自然科学基金重点项目(Z25H190001) |
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| Efficacy and nephrotoxicity of polycolistin B for carbapenem-resistant gram-negative bacilli: a single-center, retrospective, observational study |
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Yanan Bai#,Chenxia Zhu#,Rongrong Wang,Yuanzhi Ju,Yongzhong Du,Saiping Jiang
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1.Research Center for Clinical Pharmacy,College of Pharmaceutical Sciences,Zhejiang University,Hangzhou;2.Department of Clinical Pharmacy,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou;3.Department of Clinical Pharmacy,Huzhou Central Hospital,Huzhou
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| Abstract: |
| OBJECTIVE To analyze the efficacy and renal toxicity of polycolistin B （PMB） in the treatment of carbapenem-resistant gram-negative bacilli （CR-GNB）， and to provide scientific basis for the rational use of PMB. METHODS Adult patients diagnosed with CR-GNB infection from October 2021 to July 2022 who received intravenously injected polycolistin B for at least 72 hours in our hospital for the first time were retrospectively included in this study. Baseline data， clinical efficacy， and acute kidney injury （AKI） were statistically analyzed. RESULTS A total of 90 patients were included after the exclusion of 353 patients. The clearance rate of carbapenem-resistant gram-negative bacteria infected with polymyxins B（PMB） was 30.9% （21/68）， the 28-day mortality rate was 36.4% （32/88）， and the total incidence of AKI was 36.2% （25/69）. Subgroup analysis indicated that PMB clearance rate （33.3% vs 25.0%）， 28-day mortality rate （41.4% vs 26.7%） and AKI incidence rate （44.2% vs 23.1%） in ICU group showed a numerical trend higher than that in the non-ICU group， but there was no statistical difference （P > 0.05）. PMB treatment was mainly used for carbapenem-resistant Acinetobacter baumannii and respiratory tract infections in ICU group. Multivariate logistic regression analysis showed that C-reactive protein level before treatment and receiving renal replacement therapy were independent risk factors for 28-day mortality during PMB treatment. CONCLUSION Polycolistin B has limited efficacy in eradicating the pathogen of CR-GNB infection， but it still shows certain efficacy in clinical treatment. The potential nephrotoxicity of PMB should be closely monitored during administration. |
| Key words: Polycolistin B Carbapenem-resistant gram-negative bacilli Effectiveness nephrotoxicity |
