Objective  To compare the clinical efficacy of antimicrobial regimen containing polymyxin B with other antimicrobial regimens in the treatment of gram-negative bacteria hospital acquired pneumonia/ventilator associated pneumonia (HAP/VAP) by Bayesian network meta-analysis.

Methods  PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, SinoMed, ChiCTR, WanFang Data and VIP databases were electronically searched to collect the clinical control studies of antimicrobial regimen containing polymyxin B in the treatment of multidrug-resistant gram-negative bacteria HAP/VAP from inception to October 15, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The Bayesian network Meta-analysis was performed using Stata 17.0 software and R 4.1.2 software.

Results  A total of 1 randomized controlled trial (RCT) and 10 observational studies were included. A total of 1 385 cases were in-volved in 8 treatment schemes. The results of Bayesian network meta-analysis showed that: in terms of clinical efficacy, there was no significant statistical difference between the 8 drug regimens involved in this study (P>0.05), and the surface under the cumulative ranking curve (SUCRA) showed that the clinical effectiveness of polymyxin B intravenous drip combined with polymyxin B aerosol inhalation was higher than that of polymyxin B intravenous drip alone or its combination with tigecycline. In terms of fatality rate, among the 4 drug regimens involved in this study, the SUCRA showed that the case fatality rate of polymyxin B intravenous drip combined with polymyxin B aerosol inhalation was lower, which was lower than that of polymyxin B intravenous drip, tigecycline alone or a combination of the two. Among them, the case fatality rate of polymyxin B intravenous drip combined with polymyxin aerosol inhalation was lower than that of polymyxin B intravenous drip combined with tigecycline, and the difference was statistically significant (P<0.05); the remaining treatment regimens were not statistically significant (P>0.05). In terms of bacterial clearance, there was no significant statistical difference between the four drug regimens involved in this study (P>0.05).

Conclusion  The available evidence suggests that in terms of survival benefits, polymyxin B intravenous drip combined with polymyxin B aerosol inhalation was recommended to treat HAP/VAP of multi-resistant gram-negative HAP/VAP in this study. Due to the limitations of the quantity and quality in the study, the conclusions still need to be further verified by more large sample, high-quality and mul-ti-center RCTs.

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