title: Parenteral polymyxins: assessing efficacy and safety in critically ill patients with renal dysfunction.
abstract: OBJECTIVE
  Studies have established the effectiveness and safety of polymyxins in treating multidrug resistant (MDR) pathogens. However, the challenge is whether these nephrotoxic drugs can be administered in compromised renal states. The present study was undertaken to establish their role in such patients. The effectiveness and nephrotoxicity of polymyxins in critically ill-patients harboring MDR Gram-negative bacteria with already compromised renal functions was compared with those with normal renal functions.
  
  
  METHODS
  This retrospective cohort study (March 2008-March 2010) was conducted in the intensive care unit of a tertiary care hospital. A total of 48 eligible critically ill-patients receiving polymyxins were enrolled. A comparison was carried out (length of stay in hospital, mortality, renal function) between patients with acute kidney injury (AKI, n = 18; defined by the RIFLE classification) and patients with normal renal function (non-AKI, n = 30).
  
  
  RESULTS
  Patients with baseline AKI had a significantly higher adjusted mortality rate at admission when compared with the non-AKI group. At the end of therapy with polymyxins, 26.66% non-AKI patients developed renal dysfunction while 38.88% of patients in the AKI group had worsening of renal function (P = 0.006). However, there was no significant difference in the length of hospital stay (23.9 ± 13.24 vs. 30.5 ± 22.50; P = 0.406) and overall mortality (44.4% vs. 36.7%; P = 0.76) between two groups.
  
  
  CONCLUSIONS
  Polymyxins can be administered in AKI patients with favorable results provided used judiciously with strict monitoring of renal functions, dose modification according to creatinine clearance and aggressive fluid management.
authors.affiliation: Department of Pharmacology, Dr. Harvansh Singh Judge Institute of Dental Sciences, Panjab University, Chandigarh, India.
authors.forename: Kavita
authors.initials: K
authors.lastname: Sekhri
authors.affiliation: Department of Pharmacology, Dr. Harvansh Singh Judge Institute of Dental Sciences, Panjab University, Chandigarh, India.
authors.forename: Ruchika
authors.initials: R
authors.lastname: Nandha
authors.affiliation: Department of Pulmonary medicine and Critical care, Medical Intensive Care Unit, Fortis Hospital, Mohali, Punjab, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Mandal
authors.affiliation: Department of Pulmonary medicine and Critical care, Medical Intensive Care Unit, Fortis Hospital, Mohali, Punjab, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bhasin
authors.affiliation: Department of Pulmonary medicine and Critical care, Medical Intensive Care Unit, Fortis Hospital, Mohali, Punjab, India.
authors.forename: Harpal
authors.initials: H
authors.lastname: Singh
mesh_terms: D016638:Critical Illness; D006801:Humans; D007263:Infusions, Parenteral; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D007677:Kidney Function Tests; D011113:Polymyxins / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies
chemical_list: D011113:Polymyxins
keywords: Multidrug resistant Gram-negative septicemia; nephrotoxicity; polymyxin B; polymyxin E; renal dysfunction