Clinical outcomes and nephrotoxicity of colistin loading dose for treatment of extensively drug-resistant &lt;em&gt;Acinetobacter baumannii&lt;/em&gt; in cancer patients

Katip, Wasan; Uitrakul, Suriyon; Oberdorfer, Peninnah

doi:10.2147/idr.s144314

Cited by 29 publications

(28 citation statements)

References 16 publications

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“…Colistin-related nephrotoxicity rates have been reported as 6-55% in different studies [12]. The majority of these studies were performed using the RIFLE (Risk, Injury, Failure, Lost, End-stage kidney disease) or AKIN (Acute Kidney Injury Network) criteria for staging of AKI [13][14][15]. AKI was classified by using the KDIGO criteria in current studies [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of prognosis and nephrotoxicity in patients treated with colistin in intensive care unit

et al. 2020

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Introduction: Nephrotoxicity is the most important adverse effect of colistin therapy. We investigated the frequency of nephrotoxicity, risk factors related to nephrotoxicity, and its relationship with mortality in patients who received intravenous colistin in intensive care units (ICUs). Materials and methods: We retrospectively reviewed the data of patients who received intravenous colistin in ICUs between 2011 and 2017. Acute kidney injury (AKI) diagnosis and staging were made based on the Kidney Disease Improving Global Outcome criteria. Results: There were 149 patients included in the study with 61% being male. The mean age was 58.7 ± 20.3 years. AKI was detected in 96 (64.4%) patients. There were 25 patients with AKI stage 1 (16.8%) and 71 patients with AKI stage 2 or 3 (47.7%). Advanced age (65.0 vs. 47.4 years; p < .001), diabetes mellitus (p < .001), heart failure (p ¼ .01), high APACHE II score (31.7 vs. 28.08, p ¼ .019), and inotrope usage (p ¼ .01) were found as risk factors for AKI. The 14-day mortality rate was higher in the AKI group (p ¼ .027). Discussion: Higher AKI and mortality rates are observed in patients with diabetes, heart failure, advanced age and the hemodynamically impaired. However, it is a fact that there are no alternative therapies other than colistin in the treatment of multidrug-resistant Gram-negative bacterial infections. Therefore, the development of AKI in this patient group should not be considered a sufficient reason for discontinuing colistin treatment. Understanding the risk factors in this potential nephrotoxic treatment can provide a more careful patient follow-up.

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Section: Discussionmentioning

confidence: 99%

Evaluation of prognosis and nephrotoxicity in patients treated with colistin in intensive care unit

et al. 2020

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“…Among the non-modifiable risk factors, higher age has been reported in many studies [14,17,19,22,28,29,30]. However, it is not known whether there is a linear effect of age on the risk of AKI or whether the risk may increase over a given age.…”

Section: Risk Factors For Nephrotoxicitymentioning

confidence: 99%

“…The most important variable associated with the development of nephrotoxicity is polymyxin dose [14,20,24,35,36,37,38,39,46,47]. Although evaluated in a few studies, the administration of loading doses has been found to increase the risk of nephrotoxicity in some studies [28,48], but not others [18,23,38,49]. Additionally, and possibly related to total drug exposure, a longer duration of treatment has been identified by some authors [21,29].…”

Section: Risk Factors For Nephrotoxicitymentioning

confidence: 99%

Polymyxin Acute Kidney Injury: Dosing and Other Strategies to Reduce Toxicity

et al. 2019

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Polymyxins are valuable antimicrobials for the management of multidrug-resistant Gram-negative bacteria; however, nephrotoxicity associated with these drugs is a very common side effect that occurs during treatment. This article briefly reviews nephrotoxic mechanisms and risk factors for polymyxin-associated acute kidney injury (AKI) and discusses dosing strategies that may mitigate kidney damage without compromising antimicrobial activity. Polymyxins have a very narrow therapeutic window and patients requiring treatment with these drugs are frequently severely ill and have multiple comorbidities, which increases the risk of AKI. Notably, there is a significant overlap between therapeutic and toxic plasma polymyxin concentrations that substantially complicates dose selection. Recent dosing protocols for both colistin and polymyxin B have been developed and may help fine tune dose adjustment of these antibiotics. Minimizing exposure to modifiable risk factors, such as other nephrotoxic agents, is strongly recommended. The dose should be carefully selected, particularly in high-risk patients. The administration of oxidative stress-reducing drugs is a promising strategy to ameliorate polymyxin-associated AKI, but still requires support from clinical studies.

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“…Most of the previous studies [8][9][10][11] showed that extendedspectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), multidrug-resistant (MDR) Pseudomonas aeruginosa, carbapenemresistant Enterobacteriaceae (CRE), Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) have been increasingly identified as the predominant causative infection pathogens in cancer patients due to the phenomenon of antibiotics misuse [7,12]. However, antibiotics management for these infections is often limited.…”

Section: Introductionmentioning

confidence: 99%

Nosocomial Infections Due to Multidrug-Resistant Bacteria in Cancer Patients: A Seven-Year Experience of an Oncology Center in Western China

Jiang

Shi

Liu

et al. 2020

Preprint

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Abstract Background: Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. This study aimed to evaluate characteristics, antibiotic-resistant patterns, and prognosis of nosocomial infections caused by multidrug-resistant bacteria (MDR) in cancer patients. Methods: This retrospectively analyzed cancer patients with MDR bacteria caused nosocomial infections from August 2013 to May 2019 and was conducted to explore the risk factors, clinical features, outcomes, and antibiotic-resistant patterns of these infections. Results: Overall, 257 cancer patients developed nosocomial infections caused by MDR bacteria. Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae was the most frequently isolated multidrug-resistant Gram-negative bacteria (MDRGNB), followed by ESBL-producing Klebsiella pneumonia, and Acinetobacter baumannii. Cancer patients with liver disease, received intrapleural/abdominal infusion within 30 days, length of hospitalization, hemoglobin, and albumin were independent factors for 30-day mortality in the study population. The isolated MDR bacteria were highly sensitive to amikacin, meropenem, imipenem, tigecycline, and piperacillin/tazobactam. Conclusions: Cancer patients with prolonged hospitalization was an independent predictor of a favorable outcome. However, cancer patients with liver disease, received intrapleural/abdominal infusion within 30 days, anemia, and hypoproteinemia were independent risk factors of 30-day mortality.

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Clinical outcomes and nephrotoxicity of colistin loading dose for treatment of extensively drug-resistant <em>Acinetobacter baumannii</em> in cancer patients

Cited by 29 publications

References 16 publications

Evaluation of prognosis and nephrotoxicity in patients treated with colistin in intensive care unit

Evaluation of prognosis and nephrotoxicity in patients treated with colistin in intensive care unit

Polymyxin Acute Kidney Injury: Dosing and Other Strategies to Reduce Toxicity

Nosocomial Infections Due to Multidrug-Resistant Bacteria in Cancer Patients: A Seven-Year Experience of an Oncology Center in Western China

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