Abstract
BackgroundWith the rise of antibiotic resistance, polymyxin use has re-emerged but with a concern of renal toxicity. This study aims to assess mortality, length of stay, and total hospitalization cost associated with acute kidney injury (AKI) among recipients of intravenous (IV) sodium colistimethate (CMS) or IV polymyxin B (PMB).MethodsWe conducted a retrospective database analysis using the Premier database from January 1, 2012, through September 30, 2015. Adults ≥18 years of age who were admitted for inpatient treatment with ≥3 consecutive days of CMS or PMB were included. Generalized linear models compared patients who developed AKI with those who did not. Models were adjusted for patient and clinical characteristics.ResultsA total of 4886 patients were included; 4103 patients received CMS, and 783 received PMB. In the multivariable analyses, the presence of AKI was associated with higher in-hospital mortality in both the CMS cohort (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.9–2.7; P < .001) and the PMB cohort (aOR, 2.7; 95% CI, 1.8–4.2; P < .001). In both cohorts, patients who developed AKI experienced longer hospital stays (9.7 days and 11.6 days in the CMS and PMB cohorts, respectively; P < .001). The mean total hospitalization costs for patients who developed AKI were $47 820 higher (95% CI, $34 918–$60 722) in the CMS cohort and $35 244 higher (95% CI, $17 561–$52 928) in the PMB cohort.ConclusionsThe clinical and economic burden of AKI in the context of polymyxin use is substantial. The use of effective antibiotics with limited toxicity should remain a priority.
Highlights
CMS Characteristics Patient Characteristics Age (years) [mean ± SD] Gender (male) Raceb
White Black Hispanic Other Unknown Comorbidities during index admission (Charlson Comorbidity Index [CCI]) 0 1 2 3+ Previous 6-month hospital visitsc Previous 6-month hospital visitsc with AKI CKD during index admission Clinical Characteristics Average total duration of CMS[mean ± SD] Primary diagnosis for index admission SEPTICEMIA SEPTICEMIA, GRAM-NEGATIVE ORGANISM RESPIRATORY FAILURE, ACUTE & CHRONIC SEPTICEMIA—PSEUDOMONAS PNEUMONIA—PSEUDOMONAS Use of other concurrent nephrotoxic drugs Dialysis during index admission Kidney transplant during index admission Transferred to the ICU during index admission n (%) Days spent in the ICU during index admission [mean ± SD] Infection Typed SEPTICEMIA POSTOPERATIVE INFECTION BACTEREMIA Causative Organisme Pseudomonas aeruginosa Acinetobacter baumannii Klebsiella pneumoniae
0.13 ap-values calculated from t-tests; bNot mutually exclusive; percentages may not add up to 100%; cHospital visits include inpatient and outpatient visits at the same index hospital; dOnly 1726/4103 (42.1%) of patients overall had a Medicare Severity Diagnosis Related Group (MS-DRG) major diagnostic category of infection (0018); eNot mutually exclusive; Patients can have more than one causative organism; Only 744 patients in the CMS cohort had microbiological data; Note: Percentages do not add up to 100% due to conventional rounding
Summary
CMS Characteristics Patient Characteristics Age (years) [mean ± SD] Gender (male) Raceb
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