{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:05:33Z","timestamp":1785247533930,"version":"3.55.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T00:00:00Z","timestamp":1692662400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:p>Polymyxin B has been used as a last-line therapy for the treatment of carbapenem-resistant gram-negative bacterial infection. The pharmacokinetic\/pharmacodynamic index (AUC\/MIC) of polymyxin B has not been clinically evaluated, given that the broth microdilution method for polymyxin susceptibility testing is rarely used in hospitals. This study analyzed data from 77 patients with carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> infections. Among the samples, 63 <jats:italic>K. pneumoniae<\/jats:italic> isolates had MIC values of 1.0\u2009mg\/L as measured by broth microdilution but 0.5\u2009mg\/L as measured using the Vitek 2 system. Polymyxin B AUC\/MIC was significantly associated with clinical response (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) but not with 30-day all-cause mortality (<jats:italic>p<\/jats:italic>\u2009=\u20090.054). With a target AUC\/MIC value of 50, Monte Carlo simulations showed that a fixed dose of 100\u2009mg\/12\u2009h and three weight-based regimens (1.25\u2009mg\/kg\/12\u2009h for 80\u2009kg and 1.5\u2009mg\/kg\/12\u2009h for 70\u2009kg\/80\u2009kg) achieved a cumulative fraction of response &amp;gt;90% regardless of renal function, but the risk of nephrotoxicity was high. For patients with carbapenem-resistant <jats:italic>K. pneumoniae<\/jats:italic> infections, the underestimation of polymyxin resistance in automated systems need to be taken into account when optimizing polymyxin B dosing based on pharmacokinetic\/pharmacodynamic principles.<\/jats:p>","DOI":"10.3389\/fmicb.2023.1226981","type":"journal-article","created":{"date-parts":[[2023,8,22]],"date-time":"2023-08-22T09:16:33Z","timestamp":1692695793000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of polymyxin B AUC\/MIC ratio for dose optimization in patients with carbapenem-resistant Klebsiella pneumoniae infection"],"prefix":"10.3389","volume":"14","author":[{"given":"Peile","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaohua","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangzhao","family":"Qi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tongwen","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,8,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2334","DOI":"10.18502\/ijph.v51i10.10992","article-title":"Molecular detection of gyrA mutation in clinical strains of Klebsiella pneumoniae","volume":"51","author":"Ahmadi","year":"2022","journal-title":"Iran. 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Dis."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1002\/phar.2209","article-title":"International consensus guidelines for the optimal use of the polymyxins: endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)","volume":"39","author":"Tsuji","year":"2019","journal-title":"Pharmacotherapy"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1097\/FTD.0000000000000754","article-title":"A simple and robust LC-MS\/MS analytical method for therapeutic drug monitoring of plasma and cerebrospinal fluid polymyxin B1 and B2","volume":"42","author":"Wang","year":"","journal-title":"Ther. 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