Nephrotoxicity Of Polymyxin B: Experimental Study In Cells And Implications For Nursing Practice

Abstract

RESUMENEl objetivo del estudio fue caracterizar los mecanismos de daño celular implicado en la fisiopatología de la citotoxicidad de la polimixina B en las células tubulares proximales (LLC-PK1) y discutir las propuestas de intervención de enfermería para identificar a los pacientes de riesgo y considerar la prevención o el tratamiento de la lesión renal aguda nefrotóxica. Corresponde a un estudio experimental cuantitativo in vitro, en el cual las células fueron expuestas a sulfato de polimixina B. La viabilidad celular se determinó por exclusión de los colorantes fluorescentes y el método morfológico con la visualización de cuerpos apoptóticos a la microscopía de fluorescencia. Las células expuestas a polimixina B demostraron reducción de la viabilidad, aumento de célu-las apoptóticas y mayor concentración de la enzima lactato deshidrogenasa. La administración de polimixina B in vitro demostró la necesidad de realizar acciones en la práctica clínica para minimizar los efectos adversos como la nefrotoxicidad. DESCRIPTORESPolimixina B Antibacterianos Lesión renal aguda Células LLC-PK1 Atención de enfermería RESUMOO objetivo do estudo foi caracterizar os mecanismos de lesão celular envolvidos na fisiopatologia da citotoxicidade da polimixina B em células tubulares proximais (LLC-PK1) e discutir as proposições de intervenção do enfermeiro para identificar os pacientes de risco e considerar a prevenção ou o tratamento para lesão renal nefrotóxica. Estudo experimental in vitro, onde as células foram expostas ao sulfato de polimixina B. A viabilidade celular foi determinada pela exclusão dos corantes fluorescentes e o método morfológico com visualização de corpos apoptóticos à microscopia de fluorescência. As células expostas à polimixina B apresentaram redução de viabilidade, aumento do número de células em apoptose e maior concentração da enzima desidrogenase láctea. A administração de polimixina B in vitro demonstrou a necessidade de ações na prática clínica para minimizar os efeitos adversos como a nefrotoxicidade. DESCRITORESPolimixina B Antibacterianos Lesão renal aguda Células LLC-PK1 Cuidados de enfermagem ABSTRACTThe aim of the study was to characterize the cell damage mechanisms involved in the pathophysiology of cytotoxicity of polymyxin B in proximal tubular cells (LLC -PK1) and discuss about the nurses interventions to identify at risk patients and consider prevention or treatment of nephrotoxicity acute kidney injury. This is a quantitative experimental in vitro study, in which the cells were exposed to 375μM polymyxin B sulfate concentration. Cell viability was determined by exclusion of fluorescent dyes and morphological method with visualization of apoptotic bodies for fluorescence microscopy. Cells exposed to polymyxin B showed reduced viability, increased number of apoptotic cells and a higher concentration of the enzyme lactate dehydrogenase. The administration of polymyxin B in vitro showed the need for actions to minimize adverse effects such as nephrotoxicity.

<p>A Clinical Study on the Use of Intraventricular Polymyxin B Supplemented by Continuous External Ventricular Drainage in the Treatment of Drug-Resistant Gram-Negative Bacilli Intracranial Infection</p>

“…This requires a clinical search for an antibiotic that is not drugresistant for treatments to be completed. Polymyxin B, as a drug with rapid bactericidal activity, has good activity against most G-bacteria, 15 which is consistent with the results of this study. Many studies have shown that polymyxin B has a significant effect on various serious nosocomial infections caused by MDR G-bacilli such as bacteremia, urinary tract infections, abdominal infections and wound infections.…”

In Vitro Potential of Lycosin-I as an Alternative Antimicrobial Drug for Treatment of Multidrug-Resistant Acinetobacter baumannii Infections

“…The MICs of the three isomers of lycosin-I and several other clinical drugs were determined through the broth microdilution method in accordance with the CLSI protocol (Table 1; see also Table S2 in the supplemental material) (21). With MICs ranging from 8 to 32 g/ml, L-and D-lycosin-I exhibited more potent inhibitory activities against both drug-susceptible A. baumannii and MDRAB isolates than most of the traditional drugs tested, except polymyxin B, which was reported to be of high toxicity (24,25). However, no distinct differences were observed between L-and D-lycosin-I.…”

Polymyxin B-induced rhabdomyolysis

“…Polymyxin B binds to the lipopolysaccharide on the membrane of gram-negative bacteria, replacing Mg 2+ and Ca 2+ , thus destroying the bacterial cell membrane's integrity and increasing permeability. [ 1 – 3 ] Several studies have shown that polymyxin B can strengthen the antibacterial activity of other antibiotics. For example, the combined administration of polymyxin B and meropenem to treat carbapenem-resistant bacterial infections enhances the penetrative ability of meropenem and restores sensitivity.…”