Abstract：
OBJECTIVE: Polymyxin B, with its unique structure and mechanism of action, has emerged as a key therapeutic agent against Gram-negative bacteria. The study aims to explore potential factors to influence its effectiveness and safety.
METHODS: A Model-Based Meta-Analysis (MBMA) of 96 articles was conducted, focusing on factors like dosage, bacterial species, and combined antibiotic therapy. The analysis evaluated mortality rates and incidence rate of renal dysfunction, also employing parametric survival models to assess 30-day survival rates.
RESULTS: In the study involving 96 articles and 9,716 patients, polymyxin B\'s daily dose showed minimal effect on overall mortality, with high-dose group mortality at 33.57% (95% CI: 29.15-38.00) compared to the low-dose group at 35.44% (95% CI: 28.99-41.88), p=0.64. Mortality significantly varied by bacterial species, with Pseudomonas aeruginosa infections at 58.50% (95% CI: 55.42-63.58). Monotherapy exhibited the highest mortality at 40.25% (95% CI: 34.75-45.76), p<0.01. Renal dysfunction was more common in high-dose patients at 29.75% (95% CI: 28.52-30.98), with no significant difference across antibiotic regimens, p=0.54. The 30-day Overall Survival rate for monotherapy therapy was 63.6% (95% CI: 59.3-67.5) and 70.2% (95% CI: 64.4-76.2) for association therapy with β-lactam drugs.
CONCLUSIONS: The dosage of Polymyxin B doesn\'t significantly change death rates, but its effectiveness varies based on the bacterial infection. Certain bacteria like Pseudomonas aeruginosa are associated with higher mortality. Combining Polymyxin B with other antibiotics, especially β-lactam drugs, improves survival rates. Side effects depend on the dose, with lower doses being safer. These findings emphasize the importance of customizing treatment to balance effectiveness and safety.
METHODS: A Model-Based Meta-Analysis (MBMA) of 96 articles was conducted, focusing on factors like dosage, bacterial species, and combined antibiotic therapy. The analysis evaluated mortality rates and incidence rate of renal dysfunction, also employing parametric survival models to assess 30-day survival rates.
RESULTS: In the study involving 96 articles and 9,716 patients, polymyxin B\'s daily dose showed minimal effect on overall mortality, with high-dose group mortality at 33.57% (95% CI: 29.15-38.00) compared to the low-dose group at 35.44% (95% CI: 28.99-41.88), p=0.64. Mortality significantly varied by bacterial species, with Pseudomonas aeruginosa infections at 58.50% (95% CI: 55.42-63.58). Monotherapy exhibited the highest mortality at 40.25% (95% CI: 34.75-45.76), p<0.01. Renal dysfunction was more common in high-dose patients at 29.75% (95% CI: 28.52-30.98), with no significant difference across antibiotic regimens, p=0.54. The 30-day Overall Survival rate for monotherapy therapy was 63.6% (95% CI: 59.3-67.5) and 70.2% (95% CI: 64.4-76.2) for association therapy with β-lactam drugs.
CONCLUSIONS: The dosage of Polymyxin B doesn\'t significantly change death rates, but its effectiveness varies based on the bacterial infection. Certain bacteria like Pseudomonas aeruginosa are associated with higher mortality. Combining Polymyxin B with other antibiotics, especially β-lactam drugs, improves survival rates. Side effects depend on the dose, with lower doses being safer. These findings emphasize the importance of customizing treatment to balance effectiveness and safety.
摘要：
目标：多粘菌素B，以其独特的结构和作用机制，已成为针对革兰氏阴性细菌的关键治疗剂。该研究旨在探索影响其有效性和安全性的潜在因素。
方法：对96篇文献进行了基于模型的Meta分析（MBMA）。关注剂量等因素，细菌种类,和联合抗生素治疗。该分析评估了死亡率和肾功能不全的发生率，还采用参数生存模型来评估30天生存率。
结果：在涉及96篇文章和9,716名患者的研究中，多粘菌素B的每日剂量对总死亡率影响最小，高剂量组死亡率为33.57%（95%CI：29.15-38.00），低剂量组为35.44%（95%CI：28.99-41.88），p=0.64。死亡率因细菌种类而异，铜绿假单胞菌感染率为58.50%（95%CI：55.42-63.58）。单一疗法的死亡率最高，为40.25％（95％CI：34.75-45.76），p<0.01。肾功能障碍在大剂量患者中更为常见，为29.75％（95％CI：28.52-30.98），在不同的抗生素治疗方案中没有显著差异，p=0.54。单药治疗的30天总生存率为63.6%（95%CI：59.3-67.5），β-内酰胺类药物联合治疗的30天总生存率为70.2%（95%CI：64.4-76.2）。
结论：多粘菌素B的剂量没有显著改变死亡率，但其有效性因细菌感染而异。某些细菌如铜绿假单胞菌与较高的死亡率相关。多粘菌素B与其他抗生素联合使用,尤其是β-内酰胺类药物，提高生存率。副作用取决于剂量，低剂量更安全。这些发现强调了定制治疗以平衡有效性和安全性的重要性。
方法：对96篇文献进行了基于模型的Meta分析（MBMA）。关注剂量等因素，细菌种类,和联合抗生素治疗。该分析评估了死亡率和肾功能不全的发生率，还采用参数生存模型来评估30天生存率。
结果：在涉及96篇文章和9,716名患者的研究中，多粘菌素B的每日剂量对总死亡率影响最小，高剂量组死亡率为33.57%（95%CI：29.15-38.00），低剂量组为35.44%（95%CI：28.99-41.88），p=0.64。死亡率因细菌种类而异，铜绿假单胞菌感染率为58.50%（95%CI：55.42-63.58）。单一疗法的死亡率最高，为40.25％（95％CI：34.75-45.76），p<0.01。肾功能障碍在大剂量患者中更为常见，为29.75％（95％CI：28.52-30.98），在不同的抗生素治疗方案中没有显著差异，p=0.54。单药治疗的30天总生存率为63.6%（95%CI：59.3-67.5），β-内酰胺类药物联合治疗的30天总生存率为70.2%（95%CI：64.4-76.2）。
结论：多粘菌素B的剂量没有显著改变死亡率，但其有效性因细菌感染而异。某些细菌如铜绿假单胞菌与较高的死亡率相关。多粘菌素B与其他抗生素联合使用,尤其是β-内酰胺类药物，提高生存率。副作用取决于剂量，低剂量更安全。这些发现强调了定制治疗以平衡有效性和安全性的重要性。
