Evidence map›Paper›PMID 35934730›Full record

ArticleAnnals of intensive care2022

Low-dose intravenous plus inhaled versus intravenous polymyxin B for the treatment of extensive drug-resistant Gram-negative ventilator-associated pneumonia in the critical illnesses: a multi-center matched case-control study.

Jiao Liu, Min Shao, Qianghong Xu, Fen Liu, Xiaojun Pan, Jianfeng Wu, Lihong Xiong, Yueming Wu, Mi Tian, Jianying Yao and 12 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of intensive care, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
17citing papers in PubMed, 1 pooled it
6.2field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

17 citing papers in PubMed, 1 synthesis or guideline pooled it, 40 citations in OpenAlex.

  1. Pooled it
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  12. Guidelines for Antibiotics Prescription in Critically Ill Patients.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors at 12 institutions in 3 countries.

Jiao Liu *Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Min Shao *Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China.
Qianghong Xu *Department of Critical Care Medicine, Zhejiang Hospital, No.12 Lingyin Road, HangZhou, 310015, China.
Fen LiuDepartment of Critical Care Medicine, the First Affiliated Hospital of Nanchang University, No.17, YongwaiZheng Street, Nanchang, 330006, Jiangxi, China.
Xiaojun PanDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Jianfeng WuDepartment of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhongshan Er Road, Guangzhou, 510010, China.
Lihong XiongDepartment of Intensive Care Unit, The Second People's Hospital of Shenzhen, Futian District, Sungang West Road, Shenzhen, 3002518035, China.
Yueming WuEmergency and Critical Care Center, Lishui People's Hospital, No. 15 Dazhong Road, Lishui, 323000, China.
Mi TianDepartment of Intensive Care Unit, Huashan Hospital, Fudan University, No. 12 Middle Urumqi Road, Shanghai, 200040, China.
Jianying YaoDepartment of Intensive Care Unit, The First People's Hospital of KunShan, No 91, Qianjin Road, KunShan, 215300, China.
Sisi HuangDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Lidi ZhangDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Yizhu ChenDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Sheng ZhangDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Zhenliang WenDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Hangxiang DuDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
TaoWangDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Yongan LiuDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Wenzhe LiDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Yan XuDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China.
Jean-Louis TeboulService de Médecine-Intensive Réanimation, Hôpital Bicêtre, AP-HP. Université Paris-Saclay, Inserm UMR 999, Université Paris-Saclay, 94270, Le Kremlin-Bicêtre, France.
Dechang ChenDepartment of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin 2nd Road, Shanghai, 201801, China. chendechangsh@hotmail.com.
Shanghai Jiao Tong University · CNRuijin Hospital · CNAnhui Medical University · CNChinese Academy of Sciences · CNFirst People's Hospital of Kunshan · CNFudan University · CNKent State University · USLishui City People's Hospital · CNNanchang University · CNShenzhen Second People's Hospital · CNUniversité Gustave Eiffel · FRZhejiang Hospital · CN

Funding

Innovative Research Group Project of the National Natural Science Foundation of China 81971869National Natural Science Foundation of China 81873944
6 · The paper itself

Abstract

backgroundThe mortality of extensively drug-resistant Gram-negative (XDR GN) bacilli-induced ventilator-associated pneumonia (VAP) is extremely high. The purpose of this study was to compare the efficacy and safety of inhaled (IH) plus intravenous (IV) polymyxin B versus IV polymyxin B in XDR GN bacilli VAP patients.

methodsA retrospective multi-center observational cohort study was performed at eight ICUs between January 1

results151 patients and 46 patients were treated with IV polymyxin B and IH plus IV polymyxin B, respectively. XDR Klebsiella pneumoniae was the main isolated pathogen (n = 83, 42.1%). After matching on age (± 5 years), gender, septic shock, and Apache II score (± 4 points) when polymyxin B was started, 132 patients were included. 44 patients received simultaneous IH plus IV polymyxin B and 88 patients received IV polymyxin B. The rates of clinical cure (43.2% vs 27.3%, p = 0.066), bacterial eradication (36.4% vs 23.9%, p = 0.132) as well as VAP-related mortality (27.3% vs 34.1%, p = 0.428), all-cause mortality (34.1% vs 42.0%, p = 0.378) did not show any significant difference between the two groups. However, IH plus IV polymyxin B therapy was associated with improved favorable clinical outcome (77.3% vs 58.0%, p = 0.029). Patients in the different subgroups (admitted with medical etiology, infected with XDR K. pneumoniae, without bacteremia, with immunosuppressive status) were with odd ratios (ORs) in favor of the combined therapy. No patient required polymyxin B discontinuation due to adverse events. Additional use of IH polymyxin B (aOR 2.63, 95% CI 1.06, 6.66, p = 0.037) was an independent factor associated with favorable clinical outcome.

conclusionsThe addition of low-dose IH polymyxin B to low-dose IV polymyxin B did not provide efficient clinical cure and bacterial eradication in VAP caused by XDR GN bacilli. Keypoints Additional use of IH polymyxin B was the sole independent risk factor of favorable clinical outcome. Patients in the different subgroups were with HRs substantially favoring additional use of IH polymyxin B. No patients required polymyxin B discontinuation due to adverse events.

Indexed as

Critical illnessesExtensively drug-resistant Gram-negative bacilliInhalationPolymyxin BVentilator-associated pneumonia

Identifiers

PMID35934730
PMCPMC9357592
OpenAlexW4290503168

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.