Abstract
BackgroundColistin is widely used in the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB). Colistin-induced nephrotoxicity is one of the major adverse reactions during colistin treatment. Comparisons of colistin-induced nephrotoxicity between different formulations of colistin are rarely reported.MethodsIn this retrospective cohort study, we enrolled intensive care unit–admitted patients if they had culture isolates of CR-GNB and underwent intravenous treatment with colistin. The occurrence of acute kidney injury (AKI) during intravenous treatment with colistin was recorded. The occurrence of colistin-induced nephrotoxicity was compared between two formulations of colistin, Locolin®, and Colimycin®. Treatment outcomes associated with the occurrence of colistin-induced nephrotoxicity were also investigated.ResultsAmong 195 patients, 95 who were treated with Locolin® and 100 who were treated with Colimycin® were included for analysis. Patients treated with Locolin® had a higher rate of occurrence of stage 2 (46.3% vs. 32%, p = 0.040) and stage 3 (29.5% vs. 13%, p = 0.005) AKI than did those treated with Colimycin®. In multivariate analysis, the presence of septic shock (adjusted odds ratio [aOR] 2.17, 95% confidence interval [CI] 1.10–4.26) and inappropriate colistin dosage (aOR 2.52, 95% CI 1.00–6.33) were clinical factors associated with colistin-induced nephrotoxicity. Treatment with Colimycin® was an independent factor associated with a lower risk of colistin-induced nephrotoxicity (aOR 0.37, 95% CI 0.18–0.77). The mortality rate was comparable between patients with and without colistin-induced nephrotoxicity.ConclusionsThe risk of colistin-induced nephrotoxicity significantly varied in different formulations of colistin in critically ill patients. Colistin-induced nephrotoxicity was not associated with increased mortality rate.
Highlights
Colistin is widely used in the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB)
Between January 2016 and October 2018, patients admitted in the intensive care unit (ICU) were enrolled if CR-GNB, including Carbapenem-resistant-Acinetobacter baumannii complex (CRAB), Carbapenem-resistant Enterobacterales (CRE), and CR-Pseudomonas aeruginosa (CRPA), isolates was cultured from their clinical specimens and if they received intravenous colistin for ≥ 48 h
We found that independent factors associated with KDIGO stage 3 acute kidney injury (AKI) included the presence of septic shock and inappropriate colistin dosage
Summary
Colistin is widely used in the treatment of nosocomial infections caused by carbapenem-resistant gram-negative bacilli (CR-GNB). Colistin-induced nephrotoxicity is one of the major adverse reactions during colis‐ tin treatment. Carbapenem-resistant gram-negative bacilli (CR-GNB), such as CR-Acinetobacter baumannii complex (CRAB), CR-Enterobacterales. Colistin is one of the key agents used in the treatment of CR-GNB-induced nosocomial infections, especially hospital-acquired pneumonia [4]. Despite the increasing use of colistin in the treatment of nosocomial infection, the use of intravenous colistin is frequently limited by its adverse reactions, including nephrotoxicity and neurotoxicity [6,7,8,9]. Colistin-induced nephrotoxicity is characterized by decreased creatinine clearance, proteinuria, cylindruria, or oliguria, and it usually occurs in the first 5–7 days of treatment [11,12,13,14]. Acute kidney injury (AKI) is mostly alleviated within 10 days from discontinuation [13]
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