Frontiers in cellular and infection microbiology · 2026
Analysis of the efficacy and safety of intravenous injection combined with nebulized inhalation of polymyxin E sodium methanesulfonate in the treatment of carbapenem resistant gram-negative bacterial infections in the lungs.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Ma Yun, Zhang Yanrui, Wang Xiaowei, Zheng Xin, Xia Meng, Zhang Qianluo
Аннотация
BACKGROUND: Carbapenem-resistant Gram-negative (CR-GN) pneumonia remains a major therapeutic challenge due to limited effective treatment options and high morbidity. Polymyxin E sodium methanesulfonate (colistin), despite concerns of nephrotoxicity, continues to serve as a last-resort agent. The adjunctive use of nebulized polymyxin may enhance local drug delivery and improve outcomes.
OBJECTIVE: To evaluate the clinical efficacy, microbiological clearance, radiological response, and safety of combined intravenous and nebulized polymyxin E in patients with CR-GN pneumonia, and to identify early predictors of treatment response.
METHODS: This retrospective, single-center observational study included 120 adult patients with microbiologically confirmed CR-GN pneumonia treated between January 2022 and December 2024. All patients received intravenous polymyxin E along with nebulized polymyxin E (50 mg twice daily). Clinical parameters, laboratory markers, radiological findings, and adverse events were assessed at baseline (Day 0), Day 5, and Day 10-14. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify predictors of poor outcomes.
RESULTS: Significant improvements were observed across clinical parameters, including reduction in temperature (38.6 °C to 36.9 °C), respiratory rate, and improvement in oxygenation (SpO2: 90.2% to 96.1%; PaO2/FiO2: 205.4 to 326.9; p < 0.01). Inflammatory markers, including C-reactive protein and procalcitonin, showed a marked decline over time. Microbiological clearance was achieved in 73.3% of patients, with early culture conversion observed in nearly half by Day 5. Radiological improvement ≥50% was noted in 79.2% of cases. Nephrotoxicity occurred in 15% of patients, bronchospasm in 7.5%, and treatment discontinuation in 3.3%. ROC analysis identified procalcitonin >1.2 ng/mL, CRP >45 mg/L, and PaO2/FiO2 <250 as significant predictors of poor clinical outcomes.
CONCLUSION: Combined intravenous and nebulized polymyxin E therapy was associated with favorable clinical and microbiological outcomes in patients with CR-GN pneumonia, with an acceptable safety profile. Early biomarkers such as procalcitonin, CRP, and oxygenation indices may help guide risk stratification and optimize treatment strategies in critically ill patients.
OBJECTIVE: To evaluate the clinical efficacy, microbiological clearance, radiological response, and safety of combined intravenous and nebulized polymyxin E in patients with CR-GN pneumonia, and to identify early predictors of treatment response.
METHODS: This retrospective, single-center observational study included 120 adult patients with microbiologically confirmed CR-GN pneumonia treated between January 2022 and December 2024. All patients received intravenous polymyxin E along with nebulized polymyxin E (50 mg twice daily). Clinical parameters, laboratory markers, radiological findings, and adverse events were assessed at baseline (Day 0), Day 5, and Day 10-14. Multivariate logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify predictors of poor outcomes.
RESULTS: Significant improvements were observed across clinical parameters, including reduction in temperature (38.6 °C to 36.9 °C), respiratory rate, and improvement in oxygenation (SpO2: 90.2% to 96.1%; PaO2/FiO2: 205.4 to 326.9; p < 0.01). Inflammatory markers, including C-reactive protein and procalcitonin, showed a marked decline over time. Microbiological clearance was achieved in 73.3% of patients, with early culture conversion observed in nearly half by Day 5. Radiological improvement ≥50% was noted in 79.2% of cases. Nephrotoxicity occurred in 15% of patients, bronchospasm in 7.5%, and treatment discontinuation in 3.3%. ROC analysis identified procalcitonin >1.2 ng/mL, CRP >45 mg/L, and PaO2/FiO2 <250 as significant predictors of poor clinical outcomes.
CONCLUSION: Combined intravenous and nebulized polymyxin E therapy was associated with favorable clinical and microbiological outcomes in patients with CR-GN pneumonia, with an acceptable safety profile. Early biomarkers such as procalcitonin, CRP, and oxygenation indices may help guide risk stratification and optimize treatment strategies in critically ill patients.