ArticleBMC infectious diseases2026
Comparative efficacy and safety of colistin sulfate versus polymyxin B in critically ill patients with carbapenem-resistant gram-negative infections: a pilot inverse probability of treatment weighting-based retrospective cohort study.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe efficacy and safety of colistin sulfate (CS) and polymyxin B sulfate (PBS) were evaluated in critically ill patients with carbapenem-resistant Gram-negative bacteria (CR-GNB) infections, and predictors affecting clinical outcomes were identified.
methodsCR-GNB-infected ICU patients treated between February 2023 and December 2024 were retrospectively analyzed. Patients were grouped according to treatment, and inverse probability of treatment weighting (IPTW) was applied to balance confounding factors and compare clinical efficacy, microbiological clearance rates, and safety between groups. Prespecified subgroup analyses by pathogen type were conducted, with doubly robust estimation applied in the CRAB subgroup. Differences in trough concentrations (C
resultsThe CS group and the PBS group have 85 and 78 patients, respectively. Following IPTW adjustment for indication-based confounders, the two groups were well-balanced in baseline demographic characteristics, and showed no significant differences in clinical and microbiological efficacy, or in 14-day and 28-day mortality rates. However, the PBS group exhibited a significantly higher proportion of severe AKI (stages II and III) compared to the CS group (OR = 6.865, 95% CI: 1.463-32.221, P = 0.015).In prespecified subgroup analyses, the risks of both overall AKI (OR = 4.84, 95% CI 1.45-16.15, P = 0.011) and severe AKI (OR = 7.63, 95% CI 1.57-36.97, P = 0.012) were significantly elevated with PBS in patients with CRAB infection, with a significant treatment-by-pathogen interaction. No significant differences in C
conclusionsCS and PBS showed comparable clinical and microbiological efficacy. PBS was associated with a higher risk of severe AKI in the overall cohort. Notably, within the CRAB subgroup, PBS showed significantly elevated risks for both overall and severe AKI.
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