Empirical polymyxin B therapy in febrile neutropenic patients with hematological diseases: A prospective, multicenter, observational clinical study

We have read with great interest a study of Prof. Zhang regarding acute toxicity of intravenous polymyxin B: A safety and pharmacokinetic study in healthy Chinese subjects. 1 Liu X. Chen Y. Yang H. Li J. Yu J. Yu Z. et al. Acute toxicity is a dose-limiting factor for intravenous polymyxin B: A safety and pharmacokinetic study in healthy Chinese subjects. J Infect. 2021; 82: 207-215 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar In recent decades, infections caused by multiple drug-resistant (MDR)-Gram-negative bacteria (GNB) have become a major public health threat worldwide and a challenge to current antibiotic therapy. 2 Jasovský D. Littmann J. Zorzet A. Cars O. Antimicrobial resistance—a threat to the world's sustainable development. Upsala J Med Sci. 2016; 121: 159-164 Crossref PubMed Scopus (197) Google Scholar MDR-GNB are associated with high mortality, and effective empirical therapy is vital for patient survival. 3 Kollef K.E. Schramm G.E. Wills A.R. Reichley R.M. Micek S.T. Kollef MH. Predictors of 30-day mortality and hospital costs in patients with ventilator-associated pneumonia attributed to potentially antibioticresistant gram-negative bacteria. Chest. 2008; 134: 281-287 Abstract Full Text Full Text PDF PubMed Scopus (190) Google Scholar ,4 Tumbarello M. De Pascale G. Trecarichi E.M. Spanu T. Antonicelli F. Maviglia R. et al. Clinical outcomes of Pseudomonas aeruginosa pneumonia in intensive care unit patients. Intensiv Care Med. 2013; 39: 682-692 Crossref PubMed Scopus (108) Google Scholar Patients with hematological diseases are at greater risk for MDR-GNB infection because of myelosuppression, chemotherapy-induced gastrointestinal mucositis, extended hospitalization, and regular exposure to broad-spectrum antibiotic therapy. 5 Satlin M.J. Jenkins S.G. Walsh TJ. The global challenge of carbapenem-resistant Enterobacteriaceae in transplant recipients and patients with hematologic malignancies. Clin Infect Dis. 2014; 58: 1274-1283 Crossref PubMed Scopus (171) Google Scholar ,6 Misch E.A. Andes DR. Bacterial infections in the stem cell transplant recipient and hematologic malignancy patient. Infect Dis Clin N Am. 2019; 33: 399 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Colonization has also been identified as a risk factor for infection. 7 Dickstein Y. Edelman R. Dror T. Hussein K. Bar-Lavie Y. Paul M. Carbapenem-resistant enterobacteriaceae colonization and infection in critically ill patients: a retrospective matched cohort comparison with non-carriers. J Hosp Infect. 2016; 94: 54-59 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar .