Colistin nephrotoxicity in adults: Single centre large series from India

Abstract

Context:Limited Indian data are available on the rate of colistin nephrotoxicity and other risk factors contributing to the development of this important side effect.Aim:This study aims to generate data on colistin nephrotoxicity from a large cohort of Indian patients.Design:Retrospective cohort study.Materials and Methods:Case record analysis of patients who received colistin, in an oncology center in India, between January 2011 and December 2015. Nephrotoxicity was assessed using risk, injury, failure, loss, and end-stage (RIFLE) criteria.Statistical Analysis:P < 0.05 was considered as statistically significant.Results:Out of the 229 patients, 13.1% (30/229) developed abnormal RIFLE. Abnormal RIFLE group (n = 30), in comparison to the normal renal function group (n = 199), had higher number of patients in intensive care unit (ICU) (96% vs. 79%, P = 0.02), higher Acute Physiology and Chronic Health Evaluation (APACHE II) score (23 vs. 19 P = 0.0001), Charlson score (5.9 vs. 4.3, P = 0.001), mechanical ventilation (90% vs. 67%, P = 0.016), 28 days mortality (63% vs. 25%, P = 0.0001), and abnormal baseline creatinine (36% vs. 8%, P = 0.001). Coadministration of vancomycin had higher rates of nephrotoxicity (P = 0.039). There was no significant difference in nephrotoxicity between 6 and 9 MU/day dosing pattern (8.8% vs. 13.8%, P = 0.058).Conclusion:Nephrotoxicity rate in our retrospective single center large series of patients receiving colistin was 13.1%. Patients with abnormal baseline creatinine, ICU stay, and higher disease severity are at higher risk of nephrotoxicity while on colistin. A daily dose of 9 million does not significantly increase nephrotoxicity compared to the 6 million. Concomitant administration of vancomycin with colistin increases the risk of nephrotoxicity.

Retrospective Study of Nephrotoxicity Rate among Adult Patients Receiving Colistin Compared to β-lactam Antibiotics

“…This could be due to less impurities present in the newer colistin preparations and better understanding of fluid management strategies in septic patients in modern intensive care units. 4,10–12 The nephrotoxicity rate in a recently published study from our own center was 13.3%. 12 Concomitant use of vancomycin, abnormal baseline creatinine, ICU stay, and higher disease severity were associated with higher rates of nephrotoxicity in patients on colistin.…”

“…4,10–12 The nephrotoxicity rate in a recently published study from our own center was 13.3%. 12 Concomitant use of vancomycin, abnormal baseline creatinine, ICU stay, and higher disease severity were associated with higher rates of nephrotoxicity in patients on colistin. 12…”

“…12 Concomitant use of vancomycin, abnormal baseline creatinine, ICU stay, and higher disease severity were associated with higher rates of nephrotoxicity in patients on colistin. 12…”

“…In our study, the rate of kidney injury in the colistin arm was 10.2%, marginally lower than an earlier report (13.3%) from our own center and rather lower in comparison to the 16–35% reported in other Indian studies. 8,12,25,26 None of these studies, including our own earlier one, had a comparative arm with patients not receiving colistin. To the best of our knowledge, this is the first study from India comparing the nephrotoxicity in patients receiving colistin to those not receiving colistin.…”

Cryptococcal infection in HIV-infected patients with CD4+ T-cell counts under 100/μL diagnosed in a high-income country: a multicentre cohort study

“…Therapeutic doses varied greatly across the studies: for example, where intravenous colistin maintenance dosages for patients with normal renal function were reported in million Internation Units (MIU) per day, the daily dose ranged from 1 to 36 MIU. Sixteen studies in the secondary analysis population reported nephrotoxicity rates in subgroups of patients by polymyxin dose [10,17,30,52,92,106,108,113,130,151,181,198,206,215,221,232]; cutoffs varied between studies but were used to create high, intermediate and low dose subgroups that, in general, corresponded to intravenous colistin doses of more than 9 MIU per day, 6e9 MIU per day and less than 6 MIU per day, respectively (Supplementary Table S3). There was a significant difference in the rate of nephrotoxicity between subgroups of patients receiving high, intermediate and low polymyxin doses (0.446 (95% CI 0.367e0.528), 0.374 (95% CI 0.280e0.478) and 0.284 (95% CI 0.224e0.352), respectively; p 0.001; Fig.…”