Main Article Content
Objective: Colistimethate sodium (CMS) which is salvage therapy in the management of infections caused by multi-drug resistance (MDR) gram-negative pathogens is eliminated by the kidneys and cause nephrotoxicity. Many factors may also contribute to this nephrotoxic effect. In this study we aimed to determine the risks for the development of nephrotoxicity patients who received CMS in the intensive care unit (ICU).
Materials and Methods: We evaluated retrospectively of the patients who have lung cancer or COPD, aged older than 18 years, and received intravenous CMS therapy at least 72 hours in ICU. Patients’ age, comorbidities, C-reactive protein (CRP), procalcitonin, albumin, glomerular filtration rate (GFR), creatinine values on the 1st and 7th days of CMS treatment, positive inotropes, and nephrotoxic drugs used concurrently with CMS therapy, and renal replacement therapy (RRT) were recorded. RIFLE score , lenght of stay (LOS) in hospital and in the ICU, and 28-day mortality were also recorded.
Results: In this study, the GFR and creatinine level deteriorated significantly on the 7th day with CMS therapy patients who had preexisting lower GFR, hypoalbuminemia, and concomitant nephrotoxic drugs usage. The incidence of acute kidney injury was higher in malignant patients and 28-day mortality increased in patients with nephrotoxicity.
Conclusion: The CMS therapy with preexisting lower GFR, hypoalbuminemia, and concomitant nephrotoxic drugs usage significant risk factors to develop nephrotoxicity. It was also higher in malignant patients and increased 28-day mortality. Detailed clinical and laboratory evaluation of the patients is needed before CMS treatment.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
2. 2.Falagas ME, Kasiakou SK. Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections. Clin Infect Dis. 2005;40:1333-1341.
3. Velkov T, Roberts KD, Nation RL, Thompson PE, Li J. Pharmacology of polymyxins: new insights into an ‘old’ class of antibiotics. Future Microbiol. 2013;8:711-724.
4. Couet W, Grégoire N, Marchand S, Mimoz O. Colistin pharmacokinetics: the fog is lifting. Clin Microbiol Infect. 2012;18:30-39.
5. Falagas ME, Kasiakou SK. Toxicity of polymyxins:a systematic review of THA evidence from old and recent studies. Crit Care 2006;10:R27.
6. Omrani AS, Alfahad WA, Shoukri MM, Baadani AM, Aldalbahi S, Almitwazi AA et al. High dose intravenous colistin methanesulfonate therapy is associated with high rates of nephrotoxicity; a prospective cohort study from Saudi Arabia. Ann Clin Microbiol Antimicrob. 2015;14:3.
7. Kim J, Lee KH, Yoo S, Pai H. Clinical characteristics and risk factors of colistin induced nephrotoxicity. Int J Antimicrob Agents.2009;34:434-438.
8. Petrosillo N, Ioannidou E, Falagas ME. Colistin monotherapy vs. combination therapy: evidence from microbiological, animal and clinical studies. Clin Microbiol Infect. 2008; 14:816-827.
9. Joshua D. Hartzell, Robert Neff, Julie Ake, Robin Howard, Stephen Olson, Kristopher Paolino, Mark Vishnepolsky, Amy Weintrob, and Glenn Wortmann. Nephrotoxicity Associated with Intravenous Colistin (Colistimethate Sodium) Treatment at a Tertiary Care Medical Center. Clinical Infectious Diseases 2009; 48:1724-1728.
10. Fridkin SK Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med. 2001; 29:64-68.
11. Pogue JM, Lee J, Marchaim D, Yee V, Zhao JJ, Chopra T, et al. Incidence of and risk factors for colistin-associated nephrotoxicity in a large academic health system. Clin Infect Dis. 2011;53:879-884.
12. Gauthier TP, Wolowich WR, Reddy A, Cano E, Abbo L, Smith LB. Incidence and Predictors of Nephrotoxicity Associated with Intravenous Colistin in Overweight and Obese Patients. Antimicrob Agents and Chemother. 2012;56:2392-2396.
13. Rocco M, Montini L, Aleesandri E, Venditti M, Laderchi A, De Gennaro P,et al. Risk factors for acut kidney injury in critically ill patients receiving high doses of colistin methanesufonate and/or other nephrotoxic antibiotics:a retrospective cohort study.Crit Care 2013;17(4);R174.
14. Kwon KH, Oh JY, Yoon YS, Jeong YJ, Kim KS, Shin SJ, et al. Colistin treatment in carbapenem-resistant Acinetobacter baumannii pneumonia patients: Incidence of nephrotoxicity and outcomes. Int J Antimicrob Agents.2015;45:605-609.
15. Lee YJ, Wi YM, Kwon YJ, Kim SR, Chang SH, Cho S. Association between colistin dose and development of nephrotoxicity. Crit Care Med.2015;43:1187-1193.
16. Koch-Weser J, Sidel VW, Federman EB, Kanarek P, Finer DC, Eaton AE. Adverse effects of sodium colistimethate: manifestations and spe-cific reaction rates during 317 courses of therapy. Ann Intern Med 1970; 72:857-868.
17. Falagas ME, Fragoulis KN, Kasiakou SK, Sermaidis GJ, Michalopoulos A. Nephrotoxicity of intravenous colistin: a prospective evaluation. Int J Antimicrob Agents 2005; 26:504-507.
18. Hartzell JD, Neff R, Ake J, Howard R, Olson S,Paolino K, et al. Nephrotoxicity associated with intravenous colistin (colistimethate sodium) treatment at a tertiary care medical center. Clin Infect Dis 2009;48(12):1724-1728.
19. Falagas ME, Rizos M, Bliziotis IA, Rellos K, Kasiakou SK, Michalopoulos A. Toxicity after prolonged (more than four weeks) administration of intravenous colistin. BMC Infect Dis. 2005;5:1.
20. Rattanaumpawan P, Ungprasert P, Thamlikitkul V.Risk factors for colistin-associated nephrotoxicity.J Infect. 2011; 62:187-190.
21. Paul M, Bishara J, Levcovich A, Chowers M, Goldberg E, Singer P, et al. Effectiveness and safety of colistin:prospective comperative cohort study. J Antimicrob Chemother. 2010;65:1019-1027.
22. Doshi NM, Mount KL, Murphy CV. Nephrotoxicity associated with intravenous colistin in critically ill patients. Pharmacotherapy. 2011;31:1257-1264.
23. Kaya M, Tunçel YI, Kuru RN, Menteş S, Ünver S, Çeken S. Retrospective Evaluation of Colistin Associated Nephrotoxicity at Oncology Hospital Intensive Care Unit. J Turk Soc Intens Care. 2014;12:51-56.