This study evaluates the incidence and risk factors of polymyxin B-associated acute kidney injury (AKI) in patients with septic shock, a population at high risk of nephrotoxicity due to critical illness and exposure to last-line antibiotics. A prospective cohort of 200 adult patients with microbiologically confirmed multidrug-resistant gram-negative infections was analyzed. All patients received intravenous polymyxin B with standardized dosing and renal monitoring based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. AKI occurred in 25% of patients, with a median onset of 4 days following initiation of therapy. Significant risk factors included higher baseline body mass index, elevated serum urea and creatinine, reduced glomerular filtration rate, presence of comorbidities, and concomitant use of nephrotoxic agents. Structured nursing interventions and standardized monitoring enabled early detection of renal dysfunction and timely dose adjustment. These findings highlight the importance of systematic renal surveillance and individualized therapeutic strategies, including therapeutic drug monitoring, to minimize nephrotoxicity in septic shock patients receiving polymyxin B.
Li Qian (Wed,) studied this question.