Abstract
Introduction: Colistin is a cationic polypeptide antibiotic used for treatment of gram-negative infections. Nephrotoxicity is one of the most common adverse effects of colistin. Objectives: To determine the epidemiology of colistin nephrotoxicity and also to compare the changing pattern of kidney injury molecule 1 (KIM-1) in urine with serum creatinine and urine during the treatment with colistin in patients admitted to intensive care unit (ICU). Patients and Methods: During 13 months, all patients admitted to adult ICUs of two university hospitals without any documented history of acute or chronic kidney diseases receiving at least one week of colistin were included. Required demographic, clinical, and paraclinical data of the study population was collected. Urinary and serum levels of creatinine, urea, sodium, potassium, magnesium, and KIM-1 were measured at six time points including days zero, 3, 5, 7, 10, and 14 of colistin treatment. Results: Six patients (18.18%) developed nephrotoxicity during colistin treatment. Nephrotoxicity was resolved without any intervention in three individuals. None of studied demographic, clinical and laboratory characteristics of the patients had a significant association with the incidence of colistin nephrotoxicity. The pattern of KIM-1 urine level during the course of colistin treatment did not differ significantly among patients with and without nephrotoxicity. The accuracy of KIM-1 urine level in detecting colistin nephrotoxicity was significantly lower than that of serum creatinine on days 0th, 3rd, 5th and 7th. Conclusion: Nephrotoxicity of colistin is a common complication, usually reversible, KIM-1 was not more accurate than serum creatinine or urine in detecting nephrotoxicity of colistin.
Highlights
Colistin is a cationic polypeptide antibiotic used for treatment of gram-negative infections
Data collection The demographic and clinical data of the population studied included age, gender, weight, height, acute physiology and chronic health evaluation (APACHE) Acute Physiology and Chronic Health Evaluation (II) score within the first 24 hours of intensive care unit (ICU) admission [9], admission diagnosis, dose, duration of treatment, and indication of colistin, co-administered medications, possible modalities taken to control the nephrotoxicity of colistin, and clinical outcome were collected
None of the patients was under hemodialysis or continuous renal replacement therapy due to colistin nephrotoxicity and did not need to discontinue administration of the offending drug
Summary
Colistin is a cationic polypeptide antibiotic used for treatment of gram-negative infections. Nephrotoxicity is one of the most common adverse effects of colistin. Urinary and serum levels of creatinine, urea, sodium, potassium, magnesium, and KIM-1 were measured at six time points including days zero, 3, 5, 7, 10, and 14 of colistin treatment. The pattern of KIM-1 urine level during the course of colistin treatment did not differ significantly among patients with and without nephrotoxicity. The accuracy of KIM-1 urine level in detecting colistin nephrotoxicity was significantly lower than that of serum creatinine on days 0th, 3rd, 5th and 7th. Colistin (polymyxin E) is a cationic polypeptide antibiotic It was available for clinical use since 1959 [1,2]. Nephrotoxicity is the most common and worrisome adverse effects of colistin This complication is dosedependent and usually reversible. The incidence of colistin nephrotoxicity has been reported to be as high as 53.5% [6]
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