Incidence and Predictors of Nephrotoxicity Associated with Intravenous Colistin in Overweight and Obese Patients

Gauthier, Timothy P.; Wolowich, William R.; Reddy, A. Nagarjuna; Cano, Ennie; Abbo, Lilian M.; Smith, Laura

doi:10.1128/aac.00791-12

Cited by 9 publications

(12 citation statements)

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“…Obez hastalarda nefrotoksisite gelişimi %50 olarak rapor edilmiştir. 8,9 Ancak bu çalışmadaki hastaların kolistin kullanım sü-resi 14 günden az tutulmuştur. 10 Normal kilolu hastalarda ise %15'ten daha az tespit edilmiştir.…”

Section: Discussionunclassified

Evaluation of the Use of Colistin on Nephrotoxicity and Mortality in the Intensive Care Unit

Arslan¹,

Özbudak²,

Türkyılmaz³

et al. 2015

Turkiye Klinikleri J Anest Reanim

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Ö ÖZ ZE ET T A Am ma aç ç: : Kolistin, siklik yapılı katyonik polipeptidlerin bir üyesidir. Son yıllarda çoklu ilaç dirençli Pseudomonas aeruginosa ve Acinetobacter baumannii enfeksiyonlarında tek seçenek olan kolistinin nefrotoksik etkisi en önemli dezavantajıdır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Etik kurul onayı alındıktan sonra, Ocak 2012-Aralık 2013 tarihleri arasında yoğun bakım ünitesinde yatan ve çoklu ilaç dirençli gram-negatif enfeksiyon geliş-mesi nedeni ile beş günden daha fazla intravenöz 3-5 mg/kg kolistin kullanmış hastalar bu çalışmaya dâhil edildi. Yatışında böbrek fonksiyon bozukluğu saptanan hastalar çalışma dışı bırakıldı. Hastalar akut böbrek hasarı gelişen ve gelişmeyenler olarak iki gruba ayrıldı. B Bu ul lg gu ul la ar r: : İki yıl süresince, yoğun bakım ünitesinde 48 hastanın beş günden daha fazla kolistin kullandığı ve bu hastalardan beşinin geldiklerinde kronik böbrek yetersizliği olduğu tespit edildi. Kalan 43 hastanın 15 (%35)'inde akut böbrek hasarı geliştiği saptandı. Bu iki grup arasında kabulleri esnasındaki yaş, cinsiyet, APACHE II skorları, sedimentasyon ve C-reaktif protein dü-zeyleri, üreyen patojen ve üreme yerleri, ek nefrotoksik ilaç kullanımı açısından fark saptanmadı. Hastaların hepsinin mekanik ventilatöre bağlı olduğu, kolistin başlama endikasyonunun ise çoklu ilaç dirençli P. aeruginasa ve A. baumannii enfeksiyonuna bağlı ventilatörle ilişkili pnömoni olduğu saptandı. Akut böbrek hasarı gelişen grupta kolistin kullanım süresi uzundu (11,8±7,3 ve 17,7±14,3 gün; p=0,009). Akut böbrek hasarı gelişen grubun yoğun bakım ünitesinde yatış süreleri daha uzun (30±18,1 ve 46,1±29,1; p=0,04) ve mortalite oranı daha yüksekti (%80 vs %36; p=0,006). Akut böbrek hasarı gelişen grubun hepsi inotrop kullanmıştır (p<0,001). S So on nu uç ç: : Kolistin nefrotoksisitesi, kullanım süresi ile ilişkili görünmektedir. Kolistinle indüklenen nefrotoksisite gelişen hastalarda yoğun bakım ünitesinde kalış süresi uzamakta ve mortalite artmaktadır. Bu konuda yapılacak çok-merkezli çalışmalara ihtiyaç vardır.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Kolistin; ölüm oranı; yoğun bakım; akut böbrek hasarı A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Colistin is the member of the cyclic structured cationic polypeptides. In the recent years, colistin is the only choice for the multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii infections but its nephrotoxicity is the most important disadvantage. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : After research ethics committee approval, patients who had stayed in the intensive care unit more than five days and used intravenous colistin 3-5 mg/kg for multiple drug resistant gram-negative infection between January 2012 and December 2013 were enrolled in this retrospective study. Patients who had known renal function disorder before the intensive care unit acceptance were excluded from the analysis of this study. Patients were divided into two groups as; acute kidney injury develop...

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Section: Discussionunclassified

Evaluation of the Use of Colistin on Nephrotoxicity and Mortality in the Intensive Care Unit

Arslan¹,

Özbudak²,

Türkyılmaz³

et al. 2015

Turkiye Klinikleri J Anest Reanim

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“…Some recent studies have investigated the risk factors for colistin-associated NT (8,21,(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Results from previous studies are given with their significance levels in Table 5.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for colistin-associated nephrotoxicity and mortality in critically ill patients

Özkarakaş¹,

Köse²,

Zincircioğlu³

et al. 2017

Turk J Med Sci

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Background/aim: Colistin is gaining popularity against multidrug-resistant bacteria. The primary concern with colistin is its nephrotoxicity (NT). The aim of this study was to evaluate the incidence and risk factors for NT and to evaluate the risk factors for mortality in the toxicity group.Materials and methods: NT was defined according to the RIFLE criteria. Data of patients who did or did not develop NT were compared. Positive and negative predictive values, risk ratio, and correlation coefficients were calculated.Results: NT was seen in 39 patients (70%). Hypoalbuminemia, old age, and the use of vasopressors (VPs) were associated with NT. The use of VPs had the highest positive predictive value, while age had the highest negative predictive value and risk ratio. The only variable that was associated with mortality in the toxicity group was VP use. Conclusion:Aging, hypoalbuminemia, and the use of VPs were shown to be risk factors for NT, while the last of these was the only significant risk factor for mortality in the toxicity group.

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“…Bacterial sensitivity to colistin was detected only in 13 (32.5%) cases, but in other cases it was used empirically. Plachouras et al, 2009;Gauthier et al, 2012;Anonymous, 2016). MU, million units.…”

Section: Resultsmentioning

confidence: 99%

Colistin Use Patterns and Toxicity in Critically Ill Patients in Pauls Stradiņš Clinical University Hospital

Aitullina

Krūmiņa

Cauce

et al. 2018

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Colistin is used systemically in critically ill patients for treatment of infections caused by multi-drug resistant (MDR) Gram-negative bacteria, e.g., Acinetobacter baumanii. It is potentially nephro- and neurotoxic. It is recommended to decrease the dose of colistin in case of renal impairment or renal replacement therapies (RRT) but clear recommendations are not available yet. The aim of this retrospective study was to determine colistin use patterns in critically ill patients in Pauls Stradiņš University Hospital. Forty patients were included in this study. The most common indications for colistin were pneumonia associated with mechanical ventilation or sepsis caused by MDR A. baumanii. Median duration of colistin therapy was 11.5 (IQR 7.0; 17.0) days and median cumulative dose was 91.5 (43.0; 150.0) million units (MU). The usual regimen was 9 MU as loading dose and 3 MU three times daily as maintenance dose, but in case of renal impairment and RRT colistin regimens varied a lot between the patients. In 21% (7 from 33) of cases, acute kidney injury (AKI) was observed during colistin therapy (serum creatinine increases more than twice from baseline). All these AKI cases occurred in patients with previously normal renal function and none of the patients in this group needed RRT.

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Incidence and Predictors of Nephrotoxicity Associated with Intravenous Colistin in Overweight and Obese Patients

Cited by 9 publications

References 0 publications

Evaluation of the Use of Colistin on Nephrotoxicity and Mortality in the Intensive Care Unit

Evaluation of the Use of Colistin on Nephrotoxicity and Mortality in the Intensive Care Unit

Risk factors for colistin-associated nephrotoxicity and mortality in critically ill patients

Colistin Use Patterns and Toxicity in Critically Ill Patients in Pauls Stradiņš Clinical University Hospital

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