Ali Asan, Cuma Bülent Gül, İsra Karaduman, Nizameddin Koca, Canan Yılmaz, Şükran Köse, Gülsün Akınoğlu, Mustafa Özgür Akça, Derya Karasu

Nephrotoxicity rates related to colistin and evaluation of risk factors

Objectives: Colistimethate sodium (colistin) is the member of polymyxins, the cyclic structured cationicpolypeptide antibiotics. The purpose of our study is to determine the patients’ nephrotoxicity rates and riskfactors related to nephrotoxicity development that are under colistin treatment in the tertiary intensive careunit (ICU).Methods: One-hundred colistin received patients files were reviewed retrospectively, who were in tertiaryICU in Bursa Yüksek Ihtisas Training and Research Hospital. Fifteen patients with the history of renalfailurewere excluded from the study. The data before the first colistin treatment was taken into considerationfor the patients received repetitive colistin treatment. RIFLE (Risk, Injury, Failure, Loss of kidney function,and End-stage kidney disease) classification was used for the evaluation of nephrotoxicity.Results: The patients mean age was 67.81 ± 16.56 years (range: 21-94) and 52.9% were male. Nephrotoxicitywas determined in 35 (41.2%) patients. According to the RIFLE classification the nephrotoxicity rates weredetermined for risk, injury and deficiency were 24.7%, 10.6% and 5.9%, respectively. Nephrotoxicity wasdetectedin 9 (25.7%) out of 35 patients on the first day of the colistin treatment. Mortality rate was observedas 82.9% in patients with nephrotoxicity.Conclusions: Colistin treatment is preferable for the treatment of multi drug resistant infections in intensivecare unit. The patients, under certain circumstances, i.e., malignancy, using additional nephrotoxic agent andelder age must be closely monitored for the possible nephrotoxicity development.

PDF

___

1. Sümer Ş, Dikici N. [Colistin]. Yoğun Bakım Dergisi 2010;9:182-7. [Article in Turkish]
2. Rocco M, Montini L, Alessandri E, Venditti M, Laderchi A, De Pascale G, et al. Risk factors for acute kidney injury in critically ill patients receiving high intravenous doses of colistin methanesulfonate and/or other nephrotoxic antibiotics: a retrospective cohort study. Crit Care 2013;17:R174.
3. Falagas ME, Fragoulis KN, Kasiakou SK, Sermadis GJ, Michalopoulos A. Nephrotoxicity of intravenous colistin: a prospective evaluation. Int J Antimicrob Agents 2005;26:504-7.
4. Kim J, Lee KH, Yoo S, Pai H. Clinical characteristics and risk factors of colistin-induced nephrotoxicity. Int J Antimicrob Agents 2009;34:434-8.
5. Giamarellou H. Multidrug-resistant gram negative bacteria: how to treat and for how long. Int J Antimicrob Agents 2010;36 Suppl 2:S50-4.
6. Falagas ME, Kasiakou SK. Toxicity of polymiyxins: a systematic review of the evidence from old and recent studies. Crit Care 2006;10:R27.
7. Lim LM, Ly N, Anderson D, Jang JC, Macander L, Jarkowski A 3rd, et al. Resurgence of colistin: a review of resistance, toxicity, pharmacodynamics, and dosing. Pharmacotherapy 2010;30:1279-91.
8. Yahav D, Farbman L, Leibovici L, Paul M. Colistin: new lessons on an old antibiotic. Clin Microbiol Infect 2012;18:18- 29.
9. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute Dialysis Qualtiy Initiative Workgroup. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information tecnology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004;8:R204-12.
10. Pogue JM1, 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;53:879-84.
11. Deryke CA, Crawford AJ, Uddin N, Wallace MR. Colistin dosing and nephrotoxicity in a large community teaching hospital. Antimicrob Agents Chemother 2010;54:4503-5.
12. Eren E, Ata A, Arıcan A. [Drugs used in the treatment of cancer and nephrotoxicity]. DEÜ Tıp Fak Dergisi 2012;26:229- 35. [Article in Turkish]
13. Lameire N. Nefrotoxicity of recent anti-cancer agents. Clin Kidney J 2014;7:11-22.
14. Darmon M, Ciroldi M, Thiery G, Schlemmer B, Azoulay E. Clinical review: specific aspects of acute renal failure in cancer patients. Crit Care 2006;10:211-8.
15. Hachem RY, Chemaly RF, Ahmar CA, Jiang Y, Boktour MR, Rjaili GA, et al. Colistin is effective in treatment of infections caused by multidrug-resistant Pseudomonas aeruginosa in cancer patiens. Antimicrob Agents Chemother 2007;51:1905-11.
16. Kaya M, Tunçel Yİ, Kuru RN, Menteş S, Ünver S, Çeken S, et al. [Retrospective Evaluation of Colistin Associated Nephrotoxicity at Oncology Hospital Intensive Care Unit]. Türk Yoğun Bakım Dergisi 2014;12:51-6. [Article in Turkish]
17. Cheng CY, Sheng WH, Wang JT, Chen YC, Chang SC. Safety and efficacy of intravenous colistin (colistin methanesulphonate) for severe multidrug-resistant Gram-negative bacterial infections. Int J Antimicrob Agents 2010;35:297-300.
18. Mert A. [Colistin: toxicity]. Ankem Derg 2012;26:22-6. [Article in Turkish]
19. 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;53:879-84.
20. Ingram PR, Lye DC, Tambyah PA, Goh WP, Tam VH, Fisher DA. Risk factors for nephrotoxicity associated with continuous vancomycin infusion in outpatient parenteral antibiotic therapy. J Antimicrob Chemother 2008;62:168-71.
21. Ko H, Jeon M, Choo E, Lee E, Kim T, Jun J-B, et al. Early acute kidney injury is a risk factor that predicts mortality in patients treated with colistin. Nephron Clin Pract 2010;117:c284- 8.
22. Ordooei Javan A, Shokouhi S, Sahraei Z. A review on colistin nephrotoxicity. Eur J Clin Pharmacol 2015;71:801-10.