title: Parenteral colistin for the treatment of severe infections: a single center experience.
abstract: OBJECTIVE
  To describe a single center experience involving the administration of colistin to treat nosocomial infections caused by multidrug-resistant Gram-negative bacteria and identify factors associated with acute kidney injury and mortality.
  
  
  METHODS
  This retrospective longitudinal study evaluates critically ill patients with infections caused by multidrug-resistant Gram-negative bacteria. All adult patients who required treatment with intravenous colistin (colistimethate sodium) from January to December 2008 were considered eligible for the study. Data include demographics, diagnosis, duration of treatment, presence of acute kidney injury and 30-day mortality.
  
  
  RESULTS
  Colistin was used to treat an infection in 109 (13.8%) of the 789 patients admitted to the intensive care unit. The 30-day mortality observed in these patients was 71.6%. Twenty-nine patients (26.6%) presented kidney injury prior to colistin treatment, and six of these patients were able to recover kidney function even during colistin treatment. Twenty-one patients (19.2%) developed acute kidney injury while taking colistin, and 11 of these patients required dialysis. The variable independently associated with the presence of acute kidney injury was the Sequential Organ Failure Assessment at the beginning of colistin treatment (OR 1.46; 95%CI 1.20-1.79; p<0.001). The factors age (OR 1.03; 95%CI 1.00-1.05; p=0.02) and vasopressor use (OR 12.48; 95%CI 4.49-34.70; p<0.001) were associated with death in the logistic-regression model.
  
  
  CONCLUSIONS
  Organ dysfunction at the beginning of colistin treatment was associated with acute kidney injury. In a small group of patients, we were able to observe an improvement of kidney function during colistin treatment. Age and vasopressor use were associated with death.
authors.affiliation: Universidade Estadual de Londrina, Programa de Pós-Graduação, LondrinaPR, Brasil, Programa de Pós-Graduação, Universidade Estadual de Londrina - UEL - Londrina (PR), Brasil.
authors.forename: Marcos Toshyiuki
authors.initials: MT
authors.lastname: Tanita
authors.affiliation: Universidade Estadual de Londrina, Departamento de Clínica Médica, LondrinaPR, Brasil, Departamento de Clínica Médica, Universidade Estadual de Londrina - UEL - Londrina (PR), Brasil.
authors.forename: Claudia Maria Dantas de Maio
authors.initials: CM
authors.lastname: Carrilho
authors.affiliation: Universidade Estadual de Londrina, Hospital Universitário, Comitê de Controle de Infecções Hospitalares, LondrinaPR, Brasil, Comitê de Controle de Infecções Hospitalares, Hospital Universitário, Universidade Estadual de Londrina - UEL - Londrina (PR), Brasil.
authors.forename: Joseani Pascual
authors.initials: JP
authors.lastname: Garcia
authors.affiliation: Universidade Estadual de Londrina, Departamento de Clínica Médica, LondrinaPR, Brasil, Departamento de Clínica Médica, Universidade Estadual de Londrina - UEL - Londrina (PR), Brasil.
authors.forename: Josiane
authors.initials: J
authors.lastname: Festti
authors.affiliation: Universidade Estadual de Londrina, Departamento de Clínica Médica, LondrinaPR, Brasil, Departamento de Clínica Médica, Universidade Estadual de Londrina - UEL - Londrina (PR), Brasil.
authors.forename: Lucienne Tibery Queiroz
authors.initials: LT
authors.lastname: Cardoso
authors.affiliation: Universidade Estadual de Londrina, Departamento de Clínica Médica, LondrinaPR, Brasil, Departamento de Clínica Médica, Universidade Estadual de Londrina - UEL - Londrina (PR), Brasil.
authors.forename: Cintia Magalhães Carvalho
authors.initials: CM
authors.lastname: Grion
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D061605:Administration, Intravenous; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003091:Colistin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016638:Critical Illness; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; C004691:colistinmethanesulfonic acid; D003091:Colistin