A bibliometric analysis of polymyxin-induced nephrotoxicity research: Trends and insights (2005-2024)

Polymyxins remain important therapeutic options for the treatment of multidrug-resistant Gram-negative bacterial infections; however, their clinical application is limited by a narrow therapeutic window and a high risk of nephrotoxicity. Although research on polymyxin-associated nephrotoxicity has expanded rapidly in recent years, the overall evolution of research themes, knowledge structure, and emerging frontiers in this field remains unclear. This study aimed to systematically evaluate the development trends and research hotspots of polymyxin-induced nephrotoxicity using bibliometric analysis.

Relevant publications on polymyxin-induced nephrotoxicity published between January 1, 2005, and November 13, 2024, were retrieved from the Web of Science Core Collection database. CiteSpace and VOSviewer (Baxter Healthcare Corporation) were used to analyze publication trends, authorship, institutional and country collaboration networks, keyword co-occurrence, clustering, and burst detection.

A total of 569 publications were included in this study. The annual publication output demonstrated an overall increasing trend, indicating increasing attention to polymyxin-associated nephrotoxicity research. Li Jian was the most productive author, Monash University was the most productive institution in terms of publication output, and the United States contributed the highest number of publications among all countries. Keyword analysis revealed that research themes have evolved from early characterization of nephrotoxicity and clinical safety assessment toward the identification of acute kidney injury risk factors, elucidation of oxidative stress-related mechanisms, pharmacokinetic/pharmacodynamic optimization, and development of individualized dosing strategies and nephroprotective approaches. Burst analysis further indicated increasing attention toward biomarkers, precision dosing, and novel therapeutic strategies.

Bibliometric analysis revealed that research on polymyxin-induced nephrotoxicity has progressively evolved from toxicity characterization to mechanistic exploration and precision management. Current challenges include an incomplete understanding of interactions among nephrotoxic pathways, limited dynamic prediction models, and insufficient clinical translation of emerging protective strategies. Future research should focus on integrating multi-omics approaches, artificial intelligence-based risk prediction, therapeutic drug monitoring, and safer polymyxin formulations to optimize the balance between antibacterial efficacy and nephrotoxicity prevention.