title: Colistin treatment in carbapenem-resistant Acinetobacter baumannii pneumonia patients: Incidence of nephrotoxicity and outcomes.
abstract: Colistimethate sodium (CMS) is increasingly used to treat multidrug-resistant Gram-negative bacilli infections. However, the incidence of CMS-associated nephrotoxicity has not been evaluated in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia. This retrospective study included 120 patients with CRAB pneumonia treated with intravenous CMS for ≥72 h. The objective of the study was to determine risk factors for CMS-induced nephrotoxicity and 30-day mortality in patients with CRAB pneumonia. Of the 120 patients with CRAB pneumonia, 61 (51%) developed nephrotoxicity. Multivariate analysis showed that dose per ideal body weight (IBW) [odds ratio (OR)=1.28, 95% confidence interval (CI) 1.01-1.62; P=0.04], Charlson co-morbidity index (OR=1.31, 95% CI 1.06-1.60; P=0.01) and septic shock (OR=3.16, 95% CI 1.32-7.60; P=0.01) were associated with CMS-associated nephrotoxicity. Thirty-day mortality was 33% (39/120). Multivariate analysis showed that higher daily doses of CMS per IBW [hazard ratio (HR)=0.81, 95% CI 0.67-0.98; P=0.03] and longer duration of CMS therapy (HR=0.86, 95% CI 0.79-0.95; P=0.002) were associated with increased survival. Septic shock (HR=3.91, 95% CI 1.95-7.83; P<0.001) and corticosteroid use (HR=3.49, 95% CI 1.67-7.28; P=0.001) were associated with decreased survival in patients with CRAB pneumonia. Higher daily doses of CMS per IBW, Charlson comorbidity index and septic shock were significant risk factors for CMS-associated nephrotoxicity. However, CMS-associated nephrotoxicity does not appear to have an impact on mortality.
authors.affiliation: Department of Internal Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Ki Hwan
authors.initials: KH
authors.lastname: Kwon
authors.affiliation: Divisions of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Oh
authors.affiliation: Divisions of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Young-Soon
authors.initials: YS
authors.lastname: Yoon
authors.affiliation: Divisions of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Yun-Jeong
authors.initials: YJ
authors.lastname: Jeong
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Kyung Soo
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Shin
authors.affiliation: Department of Laboratory Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Laboratory Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Huh
authors.affiliation: Department of Laboratory Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Seok Lae
authors.initials: SL
authors.lastname: Chae
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Dongguk University, Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea. Electronic address: psy99ch@hanmail.net.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Park
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003091:Colistin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; C004691:colistinmethanesulfonic acid; D003091:Colistin
keywords: Carbapenem-resistant Acinetobacter baumannii; Colistimethate sodium; Nephrotoxicity; Pneumonia