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Updated: Sep 20, 2025

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Does Monitoring Total and Free Polymyxin B1 Plasma Concentrations Predict Polymyxin B-Induced Nephrotoxicity? A

Yang Deng1,2, Jun-Yuan Gu1,2, Xin Li3,4

  • 1Department of Pharmacy, The Third Hospital of Changsha, 176 Western Laodong Road, Tianxin District, Changsha, 410015, Hunan, People's Republic of China.

Infectious Diseases and Therapy
|June 11, 2022
PubMed
Abstract

Insights

The peak concentration of polymyxin B1 (PMB1) is a significant predictor of acute kidney injury (AKI) in critically ill patients. Early therapeutic drug monitoring of PMB may help prevent PMB-induced AKI.

Area of Science:

  • Pharmacokinetics and Pharmacodynamics
  • Nephrology
  • Critical Care Medicine

Background:

  • The relationship between polymyxin B (PMB) exposure and acute kidney injury (AKI) is not fully understood.
  • This study investigates the link between PMB1 and PMB2 plasma concentrations and nephrotoxicity.
  • Risk factors for PMB-induced AKI in critically ill patients are explored.

Purpose of the Study:

  • To determine the correlation between PMB exposure and AKI in critically ill patients.
  • To identify independent risk factors for PMB-induced AKI.
  • To evaluate the predictive value of PMB concentrations for AKI.

Main Methods:

  • Enrollment of critically ill patients receiving PMB.
  • Analysis of total and free plasma concentrations of PMB1 and PMB2 using liquid chromatography-tandem mass spectrometry and equilibrium dialysis.
  • Logistic regression and ROC curve analysis to identify risk factors and predictive values.

Main Results:

  • AKI developed in 28.1% of the 89 included patients.
  • Peak PMB1 concentration (Cmax(B1)), baseline BUN, and hypertension were independent risk factors for AKI.
  • Higher free Cmax(B) and free Cmax(B1) levels were observed in the AKI group.

Conclusions:

  • Cmax(B1) is a strong predictor of PMB-induced AKI.
  • Early therapeutic drug monitoring (TDM) of PMB is recommended for critically ill patients.
  • Cmax(B) and Cmax(B1) may aid in the early prediction of PMB-induced AKI.
Keywords:
Drug exposureFree concentrationIndependent risk factorsNephrotoxicityPolymyxin BPolymyxin B1

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