Abstract:

Objective To evaluate the efficacy and safety of polymyxin B in the treatment of carbapenem-resistant Gram-negative bacteria (CRGNB) infection in children. Methods From July 2020 to December 2021, 32 cases of carbapenem-resistant Gram-negative bacteria infection in PICU with using polymyxin B were retrospectively analysed. Results 20 patients enrolled in the retrospective cohort, 11 males and 9 females, with a median age of 3.4 (0.6-8.9) years; 12 were cured and 1 died. The underlying diseases were most frequently haemato-oncological system diseases (30.0%). Infection specimens from 20 patients were mainly detected in sputum or bronchoalveolar lavage fluid (75%), followed by blood (10%). Carbapenem-resistant Klebsiella pneumoniae was the most frequently isolated organism (35.0%, 7/20), followed by carbapenem-resistant Pseudomonas aeruginosa with 30% (6/20). Another 4 cases were mixed infection of multiple carbapenem-resistant Gram-negative bacilli.. All children were treated with a polymyxin B combination, with meropenem as the mainstay (9 cases, 45.0%), and no adverse reactions were observed in 20 cases. Of the 15 children with lower respiratory tract infections, a higher cure rate was observed in children with the addition of topical nebulisation compared to the intravenous administration of polymyxin B alone (P=0.002).Conclusion The efficacy and safety of polymyxin B in the treatment of severe carbapenem-resistant Gram-negative bacterial infection in children is worthy of affirmation. However, more and large-scale clinical studies are urgently needed for further exploration and evaluation..

Key words: multi-drug resistance, carbapenem-resistant Gram-negative bacterial, polymyxin B, pediatric intensive care unit