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已发表论文
比较克拉维霉素钠和多粘菌素B治疗由碳青霉烯耐药的革兰氏阴性菌引起的血流感染的疗效和安全性：一项回顾性研究
Authors Huang F , Hao Y, Li S, Zhao D, Li J, Lu X, Xu H, Li D, Kong J, Jin J, Wang J
Received 18 August 2025
Accepted for publication 24 November 2025
Published 2 December 2025 Volume 2025:18 Pages 6247—6256
DOI https://doi.org/10.2147/IDR.S555233
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Hazrat Bilal
Fang Huang,* Yan Hao,* Shifeng Li,* Daguo Zhao, Jing Li, Xiangqiong Lu, Hua Xu, Dongrong Li, Jindan Kong, Jun Jin, Jun Wang
Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jun Wang, Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People’s Republic of China, Tel +86 18606278680, Email dr_wangjun@suda.edu.cn Jun Jin, Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People’s Republic of China, Tel +86 18606278680, Email 13806214010@163.com
Background: This study aimed to compare the efficacy and safety of colistimethate sodium (CMS) and polymyxin B (PMB) in treating carbapenem-resistant Gram-negative bacteria (CR-GNB)-induced bloodstream infection (BSI) based on real-world data. While international studies on CMS and PMB have yielded conflicting results, there is a lack of direct comparative data from Chinese cohorts, where the pathogen distribution may influence outcomes.
Methods: A retrospective analysis was conducted on 373 Chinese patients with CR-GNB-induced BSI who received CMS-containing therapy (n=132) or PMB-containing therapy (n=241) between Dec 2021 and Dec 2023. Propensity score matching was used to balance the two groups at a ratio of 1:2. The primary outcome was clinical success. The secondary outcomes included inpatient days, in-hospital mortality, 28-day all-cause mortality, and incidence of adverse events. Statistical analysis was performed with Wilcoxon rank sum test, Student’s t-test, chi-square test, and Fisher’s exact test as appropriate.
Results: In this cohort, Acinetobacter baumannii was the predominant pathogen (53.4%). No significant differences were observed in efficacy outcomes between the two groups (p> 0.05). For safety, the difference in hyperpigmentation incidences between the two groups was statistically significant (CMS vs PMB: 0.0% vs 6.36%, p=0.04). Incidences of hypersensitivity, neurotoxicity, and nephrotoxicity were similar between groups (p> 0.05). A longer treatment course (> 12 days), while associated with a higher incidence of hyperpigmentation, was linked to significantly improved clinical outcomes, including higher success rate, reduced in-hospital mortality, and lower 28-day all-cause mortality (p< 0.05).
Conclusion: This study provides the first large, real-world comparative evidence from a Chinese cohort with CR-GNB BSIs. In this setting, CMS and PMB demonstrated comparable efficacy. The critical difference lay in the safety profile, with CMS associated with a markedly lower incidence of hyperpigmentation. This finding provides a tangible basis for antibiotic stewardship, positioning CMS as a valuable first-line polymyxin option.
Keywords: bloodstream infection, colistimethate sodium, carbapenem-resistant Gram-negative bacteria, polymyxin B
Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jun Wang, Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People’s Republic of China, Tel +86 18606278680, Email dr_wangjun@suda.edu.cn Jun Jin, Department of Critical Care Medicine, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou, 215006, People’s Republic of China, Tel +86 18606278680, Email 13806214010@163.com
Background: This study aimed to compare the efficacy and safety of colistimethate sodium (CMS) and polymyxin B (PMB) in treating carbapenem-resistant Gram-negative bacteria (CR-GNB)-induced bloodstream infection (BSI) based on real-world data. While international studies on CMS and PMB have yielded conflicting results, there is a lack of direct comparative data from Chinese cohorts, where the pathogen distribution may influence outcomes.
Methods: A retrospective analysis was conducted on 373 Chinese patients with CR-GNB-induced BSI who received CMS-containing therapy (n=132) or PMB-containing therapy (n=241) between Dec 2021 and Dec 2023. Propensity score matching was used to balance the two groups at a ratio of 1:2. The primary outcome was clinical success. The secondary outcomes included inpatient days, in-hospital mortality, 28-day all-cause mortality, and incidence of adverse events. Statistical analysis was performed with Wilcoxon rank sum test, Student’s t-test, chi-square test, and Fisher’s exact test as appropriate.
Results: In this cohort, Acinetobacter baumannii was the predominant pathogen (53.4%). No significant differences were observed in efficacy outcomes between the two groups (p> 0.05). For safety, the difference in hyperpigmentation incidences between the two groups was statistically significant (CMS vs PMB: 0.0% vs 6.36%, p=0.04). Incidences of hypersensitivity, neurotoxicity, and nephrotoxicity were similar between groups (p> 0.05). A longer treatment course (> 12 days), while associated with a higher incidence of hyperpigmentation, was linked to significantly improved clinical outcomes, including higher success rate, reduced in-hospital mortality, and lower 28-day all-cause mortality (p< 0.05).
Conclusion: This study provides the first large, real-world comparative evidence from a Chinese cohort with CR-GNB BSIs. In this setting, CMS and PMB demonstrated comparable efficacy. The critical difference lay in the safety profile, with CMS associated with a markedly lower incidence of hyperpigmentation. This finding provides a tangible basis for antibiotic stewardship, positioning CMS as a valuable first-line polymyxin option.
Keywords: bloodstream infection, colistimethate sodium, carbapenem-resistant Gram-negative bacteria, polymyxin B