A series of clinical cases highlighting cardiotoxicity induced by polymyxin B

Polymyxins, particularly polymyxin B, have resurfaced as critical agents against Multidrug-Resistant Organisms (MDROs) despite their historical withdrawal from clinical use due to significant nephrotoxicity and neurotoxicity. This resurgence is largely driven by the increasing prevalence of infections caused by Carbapenem-Resistant Enterobacterales (CRE) and Carbapenem-Resistant Acinetobacter Baumannii (CRAB). In this report, three clinical cases highlighting the association between polymyxin B administration and severe cardiac events, including ventricular tachycardia and cardiac arrest in patients with multiple co morbidities. The cardio toxic effects of polymyxins are attributed to their impact on cardiac myocyte ionic channels, particularly potassium channels, leading to arrhythmias and potential cardiovascular collapse. Given the rising use of polymyxins amidst escalating resistance patterns, it is imperative for clinicians to recognize and monitor for cardio toxicity, ensuring prompt intervention to mitigate risks associated with this potent antibiotic.