Evaluation of Polymyxin B-Associated Acute Kidney Injury in Carbapenem-Resistant Infections: A Systematic Review and Meta-Analysis Publisher



Elahi Vahed I ; Salehi N ; Faridafshar H ; Toozandejani B ; Kowsar A ; Khosravi F ; Gholampour N ; Ansari P ; Moonesi Shabestari N ; Rahmanian M
Source: Heliyon Published:2026

Abstract

Background and objectives Carbapenem-resistant infections pose a critical challenge in clinical practice, often necessitating the use of polymyxin B as a last-resort antibiotic. However, concerns regarding its nephrotoxicity have raised significant questions about the safety and efficacy of this treatment, particularly in high-risk patients. Methods This systematic review and meta-analysis, following PRISMA guidelines, sought to evaluate the occurrence and contributing factors of acute kidney injury (AKI) in individuals receiving polymyxin B treatment for carbapenem-resistant infections. An extensive literature search was performed across multiple databases, including Google Scholar, PubMed, Scopus, and Web of Science. The inclusion criteria encompassed studies reporting AKI incidence or related risk factors in patients treated with polymyxin B. Two independent reviewers extracted data from the selected studies. Results A total of 27 studies involving 3267 patients were included. The overall rate of AKI in the study population was 0.30 [0.24; 0.36]. Subgroup analyses revealed significant variations in AKI incidence based on patient characteristics, polymyxin B dosage, and the use of concomitant nephrotoxic drugs. Subgroup analyses further identified key predictors of AKI, such as age, baseline renal function, and concurrent nephrotoxins. Conclusions Polymyxin B treatment for carbapenem-resistant infections carries a notable risk of AKI. Careful renal monitoring and individualized treatment approaches, particularly in patients receiving additional nephrotoxic agents, are essential to minimize renal toxicity. Further research is needed to develop strategies that reduce AKI risk while ensuring effective treatment outcomes in this high-risk population. © 2025 The Authors.