Impact of Colistin Dosing on the Incidence of Nephrotoxicity in a Tertiary Care Hospital in Saudi Arabia

Abstract

Colistin therapy is associated with the development of nephrotoxicity. We examined the incidence and risk factors of nephrotoxicity associated with colistin dosing. We included adult hospitalized patients who received intravenous (IV) colistin for >72 h between January 2014 and December 2015. The primary endpoint was the incidence of colistin-associated acute kidney injury (AKI). The secondary analyses were predictors of nephrotoxicity, proportions of patients inappropriately dosed with colistin according to the Food and Drug Administration (FDA), European Medicines Agency (EMA), and Garonzik formula and clinical cure rate. We enrolled 198 patients with a mean age of 55.67 ± 19.35 years, 62% were men, and 60% were infected with multidrug-resistant organisms. AKI occurred in 44.4% (95% CI: 37.4–51.7). Multivariable analysis demonstrated that daily colistin dose per body weight (kg) was associated with AKI (OR: 1.57, 95% CI: 1.08–2.30; p = 0.02). Other significant predictors included serum albumin level, body mass index (BMI), and severity of illness. None of the patients received loading doses, however FDA-recommended dosing was achieved in 70.2% and the clinical cure rate was 13%. The incidence of colistin-associated AKI is high. Daily colistin dose, BMI, serum albumin level, and severity of illness are independent predictors of nephrotoxicity.

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“…This may be due to the use of too low doses and the development of resistance during treatment. 41 In infections caused by MDR PA, colistin is used in combination with carbapenems, fosfomycin, and aminoglycosides. The introduction of novel antibiotics active against MDR Gram-negative rods into the medical market broadens the possibilities of treating infections caused by these microorganisms.…”

Pseudomonas aeruginosa Infections in Cancer Patients

“…Moreover, none of them can be used in monotherapy [74]. In the case of colistin, the risk of nephrotoxicity may be related to the following factors: daily body dose of colistin, low serum albumin, chronic kidney disease, cancer, diabetes, anemia and other kidney diseases [75]. In oncological patients, the nephrotoxicity of this antibiotic may overlap with kidney damage resulting from anti-cancer therapy.…”

Utilization of Colistin Versus β-Lactam and β-Lactamase Inhibitor Agents in Relation to Acute Kidney Injury in Patients with Severe Gram-Negative Infections

“…However, others have shown the validity of using administrative codes for classifying incident AKI in an observational setting [ 23 , 24 ]. Higher doses of colistin have been associated with increased risk of AKI [ 25 ], but we were unable to evaluate dosing differences.…”