Exacerbation of chronic renal failure because of inhaled tobramycin in a lung transplant patient

Cuesta, Víctor Manuel Mora; Vargas, Noelia Borja; Fernández, David Iturbe; Mena, Sandra Tello; Martínez, José Manuel Cifrián

doi:10.1016/j.rmcr.2022.101584

Cited by 2 publications

(3 citation statements)

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“…Nevertheless, these findings have not been confirmed in other studies [12][13][14]. In the setting of lung transplantation, cases of drug absorption and nephrotoxicity have also been documented [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 82%

“…However, in one of the studies, the levels were not analyzed as a continuous variable, and in both cases, the drug levels were not trough drug levels. Some reported cases of suspected nephrotoxicity due to inhaled tobramycin systemic absorption have involved non-mechanically ventilated LTR [15][16][17]. In these cases, high trough tobramycin levels were detected (8.7 mg/mL [16] and 2.7 mg/mL [17]), with recovery of previous renal function observed after discontinuation of inhaled tobramycin.…”

Section: Discussionmentioning

confidence: 99%

“…However, in one of the studies, the levels were not analyzed as a continuous variable, and in both cases, the drug levels were not trough drug levels. Some reported cases of suspected nephrotoxicity due to inhaled tobramycin systemic absorption have involved non-mechanically ventilated LTR [ 15 – 17 ]. In these cases, high trough tobramycin levels were detected (8.7 mg/mL [ 16 ] and 2.7 mg/mL [ 17 ]), with recovery of previous renal function observed after discontinuation of inhaled tobramycin.…”

Section: Discussionmentioning

confidence: 99%

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Tobramycin Systemic Absorption in Lung Transplant Recipients Treated With Inhaled Tobramycin: A Cohort Study

Sempere,

Los-Arcos,

Sacanell

et al. 2024

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Inhaled tobramycin treatment has been associated with nephrotoxicity in some case reports, but limited data are available about serum levels and its possible systemic absorption in lung transplant recipients (LTR). We conducted a single-center, observational and retrospective study of all adult (>18 years old) LTR treated with inhaled tobramycin for at least 3 days between June 2019 and February 2022. Trough serum levels were collected and >2 μg/mL was considered a high drug level. The primary outcome assessed the presence of detectable trough levels, while the secondary outcome focused on the occurrence of acute kidney injury (AKI) in individuals with detectable trough levels. Thirty-four patients, with a median age of 60 years, were enrolled. The primary indications for treatment were donor bronchial aspirate bacterial isolation (18 patients) and tracheobronchitis (15 patients). In total, 28 patients (82%) exhibited detectable serum levels, with 9 (26%) presenting high levels (>2 μg/mL). Furthermore, 9 patients (26%) developed acute kidney injury during the treatment course. Median trough tobramycin levels were significantly elevated in invasively mechanically ventilated patients compared to non-ventilated individuals (2.5 μg/mL vs. 0.48 μg/mL) (p < 0.001). Inhaled tobramycin administration in LTRs, particularly in those requiring invasive mechanical ventilation, may result in substantial systemic absorption.

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Section: Introductionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

“…However, in one of the studies, the levels were not analyzed as a continuous variable, and in both cases, the drug levels were not trough drug levels. Some reported cases of suspected nephrotoxicity due to inhaled tobramycin systemic absorption have involved non-mechanically ventilated LTR [ 15 – 17 ]. In these cases, high trough tobramycin levels were detected (8.7 mg/mL [ 16 ] and 2.7 mg/mL [ 17 ]), with recovery of previous renal function observed after discontinuation of inhaled tobramycin.…”

Section: Discussionmentioning

confidence: 99%

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