Risk factors for acute kidney injury in patients treated with polymyxin B or colistin methanesulfonate sodium.
Polymyxin B (PMB) and colistin, administered as the prodrug colistin methanesulfonate sodium (CMS), are increasingly used to treat carbapenem-resistant Gram-negative bacteria. Nephrotoxicity is the major dose-limiting adverse effect of both polymyxins. A retrospective cohort study of 132 patients was conducted to evaluate risk factors for acute kidney injury (AKI), classified according to Acute Kidney Injury Network criteria, in patients treated with ≥48h of intravenous PMB or CMS, with particular focus on potential differences between each polymyxin. The overall incidence of AKI was 25.8% (34/132) [20.8% (20/96) and 38.9% (14/36) in patients treated with PMB and CMS, respectively; P=0.06]. In the Cox regression model, doses ≥2million International Units (MIU) of PMB or >9MIU of CMS were the only variable independently associated with AKI [adjusted hazard ratio (aHR)=2.11, 95% confidence interval (CI) 1.01-4.41; P=0.04]. Vancomycin co-administration was strongly associated with AKI, although this was not statistically significant (aHR=2.22, 95% CI 0.98-5.04; P=0.058). There was no statistically significant difference in the incidence of AKI between patients treated with PMB or CMS in the multivariate model (aHR=1.74, 95% CI 0.82-3.69; P=0.15). High dose was the main risk factor for AKI regardless of the polymyxin administered. Vancomycin co-administration likely increases the risk of AKI. Although there was a higher overall incidence of AKI in patients treated with CMS compared with PMB, CMS was not significantly associated with this outcome after adjusting for the above variables.
Division of Infectious Diseases, Hospital de Clínicas da Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil; Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, Brazil.
Felipe F
FF
Tuon
Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Maria Helena
MH
Rigatto
Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, Brazil.
Cesar K
CK
Lopes
Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, Paraná, Brazil.
Letícia K
LK
Kamei
Division of Microbiology, Frischmann Aisengart/DASA Medicina Diagnóstica, Curitiba, Paraná, Brazil.
Jaime L
JL
Rocha
Department of Internal Medicine, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, 2350 Rua Ramiro Barcelos, 90.035-903 Porto Alegre, RS, Brazil. Electronic address: azavascki@hcpa.ufrgs.br.
Alexandre P
AP
Zavascki
D000151:Acinetobacter Infections / Q000188:drug therapy; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000472:pathogenicity; D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology* / Q000401:mortality; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D003091:Colistin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000472:pathogenicity; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000009:adverse effects* / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000188:drug therapy; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000472:pathogenicity; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000009:adverse effects* / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D014640:Vancomycin; C004691:colistinmethanesulfonic acid; D011112:Polymyxin B; D003091:Colistin
Acute Kidney Injury Network; Acute kidney injury; Acute renal failure; Cohort study; Colistin; Creatinine; Polymyxin