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

Abstract

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.

Factors affecting colistin nephrotoxicity: Advanced age and/or other factors?

“…In the present study, we determined that age, APACHE II score, initial serum creatinine concentration, and rate of concomitant nephrotoxic agent use were higher among patients who developed nephrotoxicity and that the female sex carried a greater risk than the male sex. Similar to our results, there are studies in the literature that identify advanced age as a risk factor for COL nephrotoxicity (15,16).…”

Incidence and risk factors of nephrotoxicity associated with intravenous colistin use in the intensive care unit

“…In numerous studies, the most common site of infection is the respiratory tract, and the infectious agents are Acinetobacter, Klebsiella, and Pseudomonas spp. [1,[13][14][15], like our findings. The relationship between colistin dose, duration of use and NT are still contradictory [6,14,16].…”

“…This difference may be due to different scoring systems (AKIN, RIFLE, and KDIGO) used for renal failure [9]. In the present study, RIFLE criteria were used to determine the risk of colistin-related nephrotoxicity, as suggested by various studies [1,7,12]. Our rate of NT was higher (50% of the patients), which may be because our patient population consists of critically ill patients of advanced age and the right treatment dose of colistin could not be adjusted.…”

“…Nosocomial infections due to multi-drug resistant (MDR) gram-negative bacteria are associated with mortality, morbidity, and long hospitalization, especially in the intensive care units (ICUs) [1]. Colistin (colistimethate sodium) is one of the widely used intravenous (IV) agents in the treatment of these infections [2].…”

“…Factors affecting the risk of nephrotoxicity include age, gender, hypoalbuminemia and hyperbilirubinemia, high-dose and long-term use of colistin, use of additional nephrotoxic agents, and various comorbidities [6]. Colistin nephrotoxicity is associated with increased adverse outcomes in critically ill patients [1]. For this reason, determining the risk factors associated with nephrotoxicity is critical in preventing nosocomial infections with MDR in the ICU.…”