Colistin

Abstract

Acute kidney injury: case reportA 31-year-old man developed acute kidney injury during treatment with colistin for multiple extensively drug resistant (XDR) Acinetobacter baumannii infections.The man, who was stationed in Southeast Asia, sustained thermal burns and was shifted to a hospital in the USA. His hospitalisation course was further complicated with renal injury, XDR Acinetobacter baumannii bacteraemia and acalculous cholecystitis that required percutaneous biliary drainage. He also received renal replacement therapy. Following antimicrobial testing, he received treatment with IV colistin monotherapy for two weeks. On day 35 of hospitalisation, febrile episodes recurred and further investigation showed multiple hepatic lesions that matched the resistance profile of the previously collected isolates. Hence, he was restarted on IV colistin along with ertapenem. Two weeks later, a slight improvement in the hepatic abscesses was noted. Due to 80 days of hospitalisation and associated mental stressors, he was discharged. He continued to receive IV colistin 150mg twice a week as an outpatient treatment. However, his treatment course was complicated with acute kidney injury that initially occurred on day 35 of outpatient treatment. Laboratory investigation showed a decrease in creatinine clearance.The man's treatment with colisitin was discontinued and after 1-2 weeks, the acute kidney injury resolved.The man was restarted on colisitin, but on day 79 he again developed acute kidney injury with decreased creatinine clearance. His treatment with colisitin was discontinued and after 1-2 weeks, the acute kidney injury again resolved. Treatment with colistin was restarted at a reduced dose of 135mg twice a day. After 10 weeks an improvement in the hepatic lesions was observed and colistin was discontinued.