Colistin Dosing and Nephrotoxicity in a Large Community Teaching Hospital

DeRyke, C Andrew; Crawford, Amanda J.; Uddin, Nizam; Wallace, Mark R.

doi:10.1128/aac.01707-09

Cited by 157 publications

(174 citation statements)

References 19 publications

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“…An association between the use of diuretics and the development of AKI has been shown in previous studies (18,27). Similarly, in our study, concomitant usage of loop diuretics and higher dose colistin were identified as independent risk factors for AKI development.…”

Section: Discussionsupporting

confidence: 62%

See 1 more Smart Citation

Risk Factors for Colistin-Associated Acute Kidney Injury: A Multicenter Study from Turkey

Gül

Kuşçu²,

Aydemir

et al. 2016

Jpn J Infect Dis

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Section: Discussionsupporting

confidence: 62%

“…Although colistin has been used for more than 50 years, the levels of the most effective and least toxic doses are still unclear (18). One reason may be the different dosage recommendations included with various forms of colistin products.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Colistin-Associated Acute Kidney Injury: A Multicenter Study from Turkey

Gül

Kuşçu²,

Aydemir

et al. 2016

Jpn J Infect Dis

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“…Nephrotoxicity was the only ADR observed in UTI patients treated with colistin. Nephrotoxicity as defined earlier (DeRyke et al, 2010) was manifested in 29/80 (36.3%) patients. The mean time for onset of elevation in serum creatinine was 5.48 ± 3.41 days (mean 5 days, median 1-18 days).…”

Section: Resultsmentioning

confidence: 76%

“…Renal function tests, including serum urea and serum creatinine (SCR) levels were measured prior to starting colistin and continuously monitored throughout the duration of colistin therapy and also on first revisit where possible. Nephrotoxicity was defined as at least two consecutive SCR measurements with an increase of 0.5 mg/dl from baseline at least 24 hours apart after two or more days of colistin therapy (DeRyke et al, 2010). In patients with pre-existing renal dysfunction, renal failure was defined as an increase of SCR level ≥ 50 % compared with baseline value.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness and Safety of Colistin in Multi Drug Resistant Urinary Tract Infections

2017

J App Pharm Sci

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Colistin methanesulphonate is an inactive prodrug of which only 30% is converted to the active metabolite, colistin, in the blood and the remaining drug gets excreted unchanged in the urine. The active metabolite is eliminated through non-renal mechanisms. Hence its effectiveness in urinary tract infections (UTI) can be dubious due to the notion that no active metabolite is excreted into the bladder. But colistin has been used in clinical practice for various infections, including UTI, caused by multi drug resistant (MDR) bacteria and there is scarcity of specific reports on effectiveness of colistin in UTI. Hence the objective of our study was to evaluate the effectiveness and safety of colistin in UTI patients admitted to a tertiary care hospital. A prospective observational study was conducted on patients being treated with colistin for UTI. Safety of colistin was evaluated by assessing the causality of adverse dug reactions using Naranjo ADR probability scale and by the RIFLE criteria for severity of acute kidney injury. Clinical outcome was evaluated for each patient on completion of colistin therapy. A total of 80 patients received colistin therapy for UTI and 81% of the UTI were nosocomial. Fifty percent of UTI were relapses and urine cultures identified Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli as the causative organisms, all of which were MDR. Though colistin dosages were adjusted as per creatinine clearance 36.3% of patients experienced nephrotoxicity. Clinical cure was obtained in 80% of UTI cases. Colistin is effective for treatment of UTI caused by MDR gram negative bacteria but colistin should be used judiciously due to its potential to cause nephrotoxicity.

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“…Age, severity of the underlying disease, co-existence of septic shock, use of other nephrotoxic agents, time of exposure to colistin and cumulative dose are reported to be associated with colistin nephrotoxicity. [6,20,29] In the present study, colistin-related nephrotoxicity occurred at a rate of 19.2% and on median day 6. No correlation was found between exposure time or cumulative time and nephrotoxicity.…”

Section: Discussionmentioning

confidence: 95%

Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

et al. 2015

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Objective. To investigate whether there was a difference in mortality, clinical response and bacterial eradication between colistin monotherapy and colistin combination therapies for the treatment of nosocomial pneumonia/ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in a medical intensive care unit (ICU). Methods. This retrospective, observational and single-centre study included all patients who were in the medical ICU of Gazi University Medical Faculty Hospital and diagnosed with nosocomial pneumonia/VAP caused by A. baumannii between January 2009 and September 2014. Results. The median age of the 134 patients was 68 years and 53.3% were male. The most common causes of admission were respiratory insufficiency (66.7%) and sepsis/septic shock (54.8%). In patients with nosocomial pneumonia/VAP caused by A. baumannii, on median day 5 of admission, colistin monotherapy was used in 23 (21.6%) patients, a carbapenem combination was used in 80 (59.7%) patients, sulbactam-ampicillin combination was used in 42 (31.4%) patients, tigecycline combination was used in 26 (19.4%) patients, and sulbactam-cefoperazone combination was used in 17 (12.7%) patients. Median ICU stay of the patients was 15.5 days, and 112 (83.6%) patients died. Colistin monotherapy and combination therapies had no superiority over each other in clinical response for the treatment of A. baumannii-associated nosocomial pneumonia/VAP. Mortality was found to be higher in patients receiving the colistin-carbapenem combination (64.3% v. 36.4%, p=0.016). Discharge/day-of-death Sequential Organ Failure Assessment score (odds ratio (OR) 2.017, 95% confidence interval (CI) 1.330 -3.061) and vasopressor use (OR 9.014, 95% CI 1.360 -59.464) were independent risk factors for ICU mortality. Conclusion. Colistin monotherapy and combination therapies have no superiority over each other for clinical response in the treatment of nosocomial pneumonia/VAP caused by multidrug-resistant A. baumannii. Colistin-SAM was associated with improved microbiological eradication and colistin-carbapenem combination was associated with increased mortality.S Afr J Crit Care 2015;31(2):51-58.

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Colistin Dosing and Nephrotoxicity in a Large Community Teaching Hospital

Cited by 157 publications

References 19 publications

Risk Factors for Colistin-Associated Acute Kidney Injury: A Multicenter Study from Turkey

Risk Factors for Colistin-Associated Acute Kidney Injury: A Multicenter Study from Turkey

Effectiveness and Safety of Colistin in Multi Drug Resistant Urinary Tract Infections

Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

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