Incidence and Risk Factors for Colistin-Associated Nephrotoxicity

Temoçin, Fatih; Erdinç, Şebnem; Tülek, Necla; Demirelli, Meryem; Bulut, Cemal; Ertem, Günay Tuncer

doi:10.7883/yoken.jjid.2014.223

Cited by 38 publications

(30 citation statements)

References 13 publications

(10 reference statements)

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“…Temocin et al reported a similarly low NT rate (48%); however, they did not specify the disease severity scores or comorbidities of patients, which may contribute to NT (23).…”

Section: Discussionmentioning

confidence: 97%

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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“…Temocin et al reported a similarly low NT rate (48%); however, they did not specify the disease severity scores or comorbidities of patients, which may contribute to NT (23).…”

Section: Discussionmentioning

confidence: 97%

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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“…Undoubtedly, nephrotoxicity is the most clinically relevant and dose‐limiting adverse reaction of the polymyxins. The incidence of nephrotoxicity varies widely in the literature from 0% to more than 60% largely due to heterogeneous patient populations, differing definitions of nephrotoxicity, wide ranges of polymyxin doses administered, and differences in both severity of illness and the presence/absence of various other risk factors for the patients being studied . Contemporary studies, using commonly accepted polymyxin doses and AKI definitions, place the rate of associated nephrotoxicity in the 20–50% range for both polymyxins …”

Section: Clinical Questions and Recommendationsmentioning

confidence: 99%

International Consensus Guidelines for the Optimal Use of the Polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti‐infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)

et al. 2019

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The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram‐negative infections. Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B. We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti‐Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP). The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement. The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin‐based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure. The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use.

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“…When P. aeruginosa is resistant to all other treatment options, which has been occurring with increasing frequency, clinicians may opt to use polymyxins due to a lack of alternative options, despite their high rate of associated nephrotoxicity. Nephrotoxicity rates of 30–50% are seen with both colistin and polymyxin B . Other limitations of the polymyxins include the lack of a well‐defined optimal dosing regimen for colistin and a lack of clinical experience with polymyxin B .…”

Section: Treatment Regimens For Resistant Gram‐negative Infectionsmentioning

confidence: 99%

“…Nephrotoxicity rates of 30-50% are seen with both colistin and polymyxin B. 50,51 Other limitations of the polymyxins include the lack of a well-defined optimal dosing regimen for colistin and a lack of clinical experience with polymyxin B. 12 A comprehensive review of the polymyxins is beyond the scope of this manuscript but may be found elsewhere.…”

Section: Treatment Regimens For Resistant Gram-negative Infectionsmentioning

confidence: 99%

Infections Caused by Resistant Gram-Negative Bacteria: Epidemiology and Management

2015

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Infections caused by resistant gram-negative bacteria are becoming increasingly prevalent and now constitute a serious threat to public health worldwide because they are difficult to treat and are associated with high morbidity and mortality rates. In the United States, there has been a steady increase since 2000 in rates of extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii, particularly among hospitalized patients with intraabdominal infections, urinary tract infections, ventilator-associated pneumonia, and bacteremia. Colonization with resistant gram-negative bacteria is common among residents in long-term care facilities (particularly those residents with an indwelling device), and these facilities are considered important originating sources of such strains for hospitals. Antibiotic resistance is associated with a substantial clinical and economic burden, including increased mortality, greater hospital and antibiotic costs, and longer stays in hospitals and intensive care units. Control of resistant gram-negative infections requires a comprehensive approach, including strategies for risk factor identification, detection and identification of resistant organisms, and implementation of infection-control and prevention strategies. In treating resistant gram-negative infections, a review of surveillance data and hospital-specific antibiograms, including resistance patterns within local institutions, and consideration of patient characteristics are helpful in guiding the choice of empiric therapy. Although only a few agents are available with activity against resistant gram-negative organisms, two recently released β-lactam/β-lactamase inhibitor combinations - ceftolozane/tazobactam and ceftazidime/avibactam - have promising activity against these organisms. In this article, we review the epidemiology, risk factors, and antibiotic resistance mechanisms of gram-negative organisms. In addition, an overview of treatment options for patients with these infections is provided.

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Incidence and Risk Factors for Colistin-Associated Nephrotoxicity

Cited by 38 publications

References 13 publications

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

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

Infections Caused by Resistant Gram-Negative Bacteria: Epidemiology and Management

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