title: Risk factors for nephrotoxicity onset associated with polymyxin B therapy.
abstract: OBJECTIVE
  Polymyxin B is an active agent against many MDR Gram-negative bacteria, but nephrotoxicity is a major hindrance to its widespread use. To guide its optimal use, we determined the risk factors for nephrotoxicity onset associated with polymyxin B.
  
  
  METHODS
  In a multicentre, retrospective, cohort study, we evaluated adult patients with normal renal function who received ≥72 h of polymyxin B therapy. Pertinent information was retrieved from medical records; patients were followed for up to 30 days after therapy was started. The primary endpoint of this study was the onset of nephrotoxicity. A Cox proportional hazards model was used for analysis.
  
  
  RESULTS
  A total of 192 patients (52.1% male, 67.7% Caucasian) were evaluated. The mean ± SD age, actual body weight (ABW) and daily dose by ABW were 68.3 ± 17.2 years, 71.5 ± 20.4 kg and 1.5 ± 0.5 mg/kg, respectively. The median duration of therapy was 9.5 days. The overall prevalence rate of nephrotoxicity was 45.8% and the median onset of nephrotoxicity was 9 days. Independent risk factors for the onset of nephrotoxicity included daily dose by ABW (HR = 1.73; P = 0.022), concurrent use of vancomycin (HR = 1.89; P = 0.005) and contrast media (HR = 1.79; P = 0.009). Nephrotoxicity was seen earlier in the high-risk group (P = 0.003).
  
  
  CONCLUSIONS
  Risk factors for nephrotoxicity onset associated with polymyxin B were identified. In conjunction with susceptibility and other pharmacokinetic/pharmacodynamic data, our results can be used to optimize treatment for MDR Gram-negative infections.
authors: Department of Pharmacy, New York University Langone Medical Center, New York, NY, USA.
authors: Yanina
authors: Y
authors: Dubrovskaya
authors: The Dr. James J. Rahal, Jr. Division of Infectious Diseases, New York Hospital Queens, Flushing, NY, USA.
authors: Nishant
authors: N
authors: Prasad
authors: Department of Pharmacy, Maimonides Medical Center, Brooklyn, NY, USA.
authors: Yuman
authors: Y
authors: Lee
authors: Department of Pharmacy, New York University Langone Medical Center, New York, NY, USA.
authors: Diana
authors: D
authors: Esaian
authors: Department of Pharmacy, New York Hospital Queens, Flushing, NY, USA.
authors: Deborah A
authors: DA
authors: Figueroa
authors: Department of Clinical Sciences and Administration, University of Houston College of Pharmacy, Houston, TX, USA vtam@uh.edu.
authors: Vincent H
authors: VH
authors: Tam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000008:administration & dosage / Q000009:adverse effects*; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B
keywords: MDR Gram-negative infections; model; nephrotoxic