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Updated: Jan 6, 2026

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
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Optimizing Polymyxin B Therapy in Critical Care: Pharmacokinetic Insights and Clinical Outcomes in a Retrospective

Qingyun Peng1, Qing Li1, Mengru Xiong1

  • 1Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No. 87, Dingjiaqiao Road, Gulou District, Nanjing, 210009, Jiangsu, People's Republic of China.

Infectious Diseases and Therapy
|September 20, 2025
PubMed
Abstract

Insights

Polymyxin B (PMB) pharmacokinetics significantly impact outcomes in critically ill patients. Achieving an area under the concentration-time curve (AUCss, 24 h) of at least 81.6 mg·h/l may reduce mortality, while baseline eGFR and treatment duration influence acute kidney injury risk.

Area of Science:

  • Pharmacology and pharmacokinetics
  • Critical care medicine
  • Infectious diseases

Background:

  • Carbapenem-resistant Gram-negative bacteria present a critical global health challenge.
  • Polymyxin B (PMB) is a last-resort antibiotic for these infections, but its use is limited by nephrotoxicity and neurotoxicity concerns.
  • The relationship between PMB exposure and patient outcomes (efficacy and toxicity) requires further elucidation.

Purpose of the Study:

  • To investigate the impact of Polymyxin B pharmacokinetics on clinical outcomes in critically ill patients.
  • To identify pharmacokinetic parameters associated with mortality and acute kidney injury (AKI).
  • To determine optimal therapeutic targets for PMB to improve patient outcomes.

Main Methods:

  • A retrospective study of 146 critically ill patients treated with PMB.
  • Analysis of 28-day mortality, clinical efficacy, hospital/ICU length of stay, and new-onset AKI.
  • Multivariable Cox regression and ROC analysis to identify predictors of mortality and AKI.

Main Results:

  • The 28-day mortality rate was 43.2%.
  • PMB pharmacokinetic parameters, including AUCss, 24 h, C6h, and Cmin, were associated with mortality.
  • An AUCss, 24 h cutoff of 81.6 mg·h/l predicted mortality. AKI occurred in 40.6% of patients, with baseline eGFR and PMB duration as independent risk factors.

Conclusions:

  • Polymyxin B pharmacokinetics are strongly correlated with patient outcomes.
  • An AUCss, 24 h ≥ 81.6 mg·h/l may be associated with reduced mortality.
  • Baseline eGFR and PMB treatment duration are critical factors for predicting AKI in patients receiving PMB therapy.
Keywords:
Clinical outcomesMultidrug-resistant bacterial infectionPharmacokineticsPolymyxin B

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