Parenteral colistin for the treatment of severe infections: a single center experience

Abstract

ObjectiveTo describe a single center experience involving the administration of colistin to treat nosocomial infections caused by multidrug-resistant Gram-negative bacteria and identify factors associated with acute kidney injury and mortality.MethodsThis retrospective longitudinal study evaluates critically ill patients with infections caused by multidrug-resistant Gram-negative bacteria. All adult patients who required treatment with intravenous colistin (colistimethate sodium) from January to December 2008 were considered eligible for the study. Data include demographics, diagnosis, duration of treatment, presence of acute kidney injury and 30-day mortality.ResultsColistin was used to treat an infection in 109 (13.8%) of the 789 patients admitted to the intensive care unit. The 30-day mortality observed in these patients was 71.6%. Twenty-nine patients (26.6%) presented kidney injury prior to colistin treatment, and six of these patients were able to recover kidney function even during colistin treatment. Twenty-one patients (19.2%) developed acute kidney injury while taking colistin, and 11 of these patients required dialysis. The variable independently associated with the presence of acute kidney injury was the Sequential Organ Failure Assessment at the beginning of colistin treatment (OR 1.46; 95%CI 1.20-1.79; p<0.001). The factors age (OR 1.03; 95%CI 1.00-1.05; p=0.02) and vasopressor use (OR 12.48; 95%CI 4.49-34.70; p<0.001) were associated with death in the logistic-regression model.ConclusionsOrgan dysfunction at the beginning of colistin treatment was associated with acute kidney injury. In a small group of patients, we were able to observe an improvement of kidney function during colistin treatment. Age and vasopressor use were associated with death.

Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria

“…Our study represents one of the largest cohorts of patients treated with intravenous colistin reported in the literature, and the largest to define AKI using the KDIGO clinical practice guideline criteria [ 14 , 18 ]. We have applied these criteria to the first 48 hours and 7 days of colistin treatment, which allows for a dynamic assessment of risk factors early, and over time.…”

“…By unifying criteria for AKI, clinicians and researchers are armed with improved tools to elucidate risk factors for drug-induced AKI within specific populations. Notably, the KDIGO criteria have been rarely applied to patients receiving colistin [ 18 ]. Our objective was to determine the incidence and risk factors for colistin-induced AKI by KDIGO criteria during an era of PK-driven colistin dosing.…”

Carbapenem-Resistant but Cephalosporin-Susceptible Pseudomonas aeruginosa in Urinary Tract Infections: Opportunity for Colistin Sparing

“…Although the overlap between these resistance mechanisms may be significant, cases of Car-R/Ceph-S may be identified where the use of cephalosporins instead of colistin may be warranted [36]. Colistin is currently considered a last-resort, life-saving antibiotic for resistant Gram-negative infections [37]. Irrespective of its disadvantagous adverse effects and difficult dosing, based on pharmaco-epidemiological studies, the use of this agent is on the rise [38].…”

Lesão renal aguda associada ao uso de polimixinas em pacientes críticos

“…3 Contudo, poucos estudos de ordem nacional, ou até mesmo internacional, avançaram em detalhar dados clínicos relacionados à essa toxicidade e fornecer informações mais precisas sobre a sua incidência em pacientes em situação de gravidade exacerbada. [4][5][6][7] As primeiras descrições de LRA datam da primeira metade do século XX, Desde então, em que pesem os avanços científicos principalmente nos recursos relativos à terapêutico, como o desenvolvimento tecnológico hospitalar, a evolução do arsenal de equipamentos e fármacos e a incorporação de melhor manejo clínico do paciente crítico com LRA, não se constatou redução na incidência, prevalência e mortalidade da LRA. 2,8 Estudos mais consistentes demonstram uma incidência hospitalar da LRA em torno de 5%, enquanto que nas UTIs chega a 40%, e conta com uma mortalidade superior a 50%.…”

“…2,[9][10][11] Nas UTIs, pacientes com LRA necessitam de maior suporte respiratório, hemodinâmico e terapia de substituição renal (TSR), o que resulta em acréscimo de dias de internação e custos hospitalares. 4,12,13 Entre as etiologias mais frequentes de LRA destacam-se a sepse, a hipovolemia, a insuficiência cardíaca, a nefrotoxicidade por fármacos, o trauma cirúrgico, a obstrução urológica e a transfusão sanguínea incompatível. 16 Destacase ainda a sepse como a causa mais comum de LRA nas UTIs no mundo, chegando até 40% dos casos.…”