Nephrotoxicity Associated with Intravenous Colistin in Critically Ill Patients
- 1 December 2011
- journal article
- Published by Wiley in Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy
- Vol. 31 (12), 1257-1264
- https://doi.org/10.1592/phco.31.12.1257
Abstract
To determine the frequency of nephrotoxicity associated with colistin therapy by using a standardized definition and to identify risk factors for colistin-induced nephrotoxicity in critically ill patients. Single-center, retrospective cohort analysis. University-affiliated tertiary care center. Forty-nine adults admitted to an intensive care unit who received intravenous colistin for at least 48 hours between July 2007 and July 2009. Nephrotoxicity was determined by using the standardized RIFLE criteria: risk, injury, failure, loss, and end-stage renal disease. Patients who had end-stage renal disease or required renal replacement therapy before initiation of colistin were excluded. Of the 49 patients included in the analysis, 15 (31%) developed nephrotoxicity, and only two patients (4%) had irreversible cases. Patients with chronic kidney disease (40% in the group with nephrotoxicity vs 3% in the group without nephrotoxicity, p=0.002) and hypertension (87% vs 56%, p=0.037) at baseline had a higher risk of developing nephrotoxicity. In addition, patients with nephrotoxicity were more likely to have received intravenous contrast material (33% vs 0%, p=0.002). The risk of developing nephrotoxicity was 6.5 times higher in patients who had been given at least two concomitant nephrotoxic agents compared with no other nephrotoxic agents (p=0.034). The frequency and severity of colistin-induced nephrotoxicity in critically ill patients was consistent with previous reports in non-critically ill patients. Most cases of nephrotoxicity demonstrated in this study were mild and reversible. Patients receiving colistin therapy who have hypertension or chronic kidney disease should be monitored closely, and administration of additional nephrotoxic agents should be avoided in all patients when possible. Large, prospective trials are warranted to confirm these results.Keywords
This publication has 17 references indexed in Scilit:
- Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY Antimicrobial Surveillance Program (2006-09)Journal of Antimicrobial Chemotherapy, 2011
- Nephrotoxicity Associated with Intravenous Colistin (Colistimethate Sodium) Treatment at a Tertiary Care Medical CenterClinical Infectious Diseases, 2009
- Safety and efficacy of colistin compared with imipenem in the treatmentof ventilator-associated pneumonia: a matched case–control studyIntensive Care Medicine, 2007
- Toxicity of polymyxins: a systematic review of the evidence from old and recent studiesCritical Care, 2006
- Nephrotoxicity of intravenous colistin: a prospective evaluationInternational Journal of Antimicrobial Agents, 2005
- Overview of Nosocomial Infections Caused by Gram-Negative BacilliClinical Infectious Diseases, 2005
- Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort studyIntensive Care Medicine, 2005
- Polymyxin B Sulfate and Colistin: Old Antibiotics for Emerging Multiresistant Gram-Negative BacteriaAnnals of Pharmacotherapy, 1999
- Effects of Polymyxin B on Mammalian Urinary BladderThe Journal of Membrane Biology, 1996
- Effects of Large Doses of Colistin Sulphomethate Sodium on Renal FunctionBMJ, 1970