Determination of Colistin-Related Nephrotoxicity and Risk Factors in Intensive Care Unit

Abstract

OBJECTIVE:Colistin is a cationic polypeptide antibiotic with a cyclic structure that belongs to the polymyxin group. It was banned from clinical use because of its significant renal side effects, such as nephrotoxicity. However, the administration of colistin has recently been initiated again in the treatment of multi-drug resistant pathogens, such as Acinetobacter baumannii and Pseudomonas aeruginosa. Nephrotoxicity and neurotoxicity are the main problems encountered in the clinical use of polymyxins. The aim of this study was to determine the frequency and risk factors of colistin-related nephrotoxicity in the adult intensive care unit (ICU).METHODS:In this study, a retrospective review of patients who were followed up between January 1 and December 31, 2016 and who received colistin treatment in the adult ICU was performed. Retrospective computer records of age, sex, site of infection and microorganism breeding, daily creatinine values, and additional diseases were recorded and examined. Nephrotoxicity was assessed using the Risk, Injury, Failure, Loss, and End-stage kidney disease criteria.RESULTS:A total of 48 patients were included in the study. Of these, 50% were male. The mean age of the patients with nephrotoxicity was 59.73±22.38 years, and the mean age of those without nephrotoxicity was 58.00±22.39 years. A. baumanni was observed to be the causative microorganism in all patients, and the most frequent infection was pneumonia. Nephrotoxicity was investigated in 54.2% (n=26) of the patients. In this study, when risk factors for nephrotoxicity were evaluated, it was found that the presence of nephrotoxicity was greater in cases with chronic obstructive pulmonary disease, malignancy, or abdominal surgery in patients older than 65 years. In addition, mortality was greater in those who developed nephrotoxicity, although it was not statistically significant.CONCLUSION:In this study, the rate of nephrotoxicity was 54.2% in patients who received colistin in the ICU. Therefore, patients in the adult ICU receiving colistin therapy should be carefully monitored for the development of nephrotoxicity as a side effect.

Prevalence of polymyxin-induced nephrotoxicity and its predictors in critically ill adult patients: A meta-analysis

“…The sample sizes per study ranged from 11 to 4910 critically ill patients. This systematic review and meta-analysis included 3 parallel cohort studies that reported outcome measures associated with colistin and PMB use[ 62 , 76 , 80 ], 2 studies with colistin and PMB use[ 17 , 68 ], 75 studies with colistin use alone[ 16 , 18 - 40 , 42 - 57 , 59 - 61 , 64 - 67 , 70 - 75 , 78 , 81 , 83 - 99 , 101 - 102 , 104 ] and 9 studies with PMB use alone[ 41 , 58 , 63 , 69 , 77 , 79 , 82 , 100 , 103 ]. Regarding the geographical distribution, 35 studies were conducted in Europe, 31 in Asia, 6 in North America, 6 in South America and 4 in Africa.…”

Synergistic Activity and Biofilm Formation Effect of Colistin Combined with PFK-158 Against Colistin-Resistant Gram-Negative Bacteria

“…Finally, it is crucial to evaluate the clinical significance of these observations and to better understand the doseresponse relationships of a combination of colistin with PFK-158. As we all know, colistin has the nephrotoxicity and neurotoxicity 41 thus, if the combination therapy can lower the concentration and dosage of colistin, it will be extremely meaningful for the clinical treatment of colistinresistant GNB infections, especially for the patients with cancer, who are a special group with the low immunity and are more prone to be infected. Therefore, further clinical study is recommended to assess the potential application of the combination of the two drugs in clinical practice.…”

Synergistic activity of colistin combined with PFK-158 against colistin-resistant and colistin-susceptible Gram-negative bacteria

“…Finally, it is crucial to evaluate the clinical signi cance of these observations and to better understand the dose-response relationships of combination of colistin combined with PFK-158. As we all know, colistin has the nephrotoxicity and neurotoxicity [27], thus, if the combination therapy can lower the concentration and dosage of colistin, it will be extremely meaningful for the clinical treatment of colistin-resistant and colistin-susceptible Gram-negative bacteria infections, especially for the patients with cancer, who are a special group with the low immunity and are more prone to be infected.…”