title: Multicenter Prospective Cohort Study of Renal Failure in Patients Treated with Colistin versus Polymyxin B.
abstract: Nephrotoxicity is the main adverse effect of colistin and polymyxin B (PMB). It is not clear whether these two antibiotics are associated with different nephrotoxicity rates. We compared the incidences of renal failure (RF) in patients treated with colistimethate sodium (CMS) or PMB for ≥48 h. A multicenter prospective cohort study was performed that included patients aged ≥18 years. The primary outcome was renal failure (RF) according to Risk, Injury, Failure, Loss, and End-stage renal disease (RIFLE) criteria. Multivariate analysis with a Cox regression model was performed. A total of 491 patients were included: 81 in the CMS group and 410 in the PMB group. The mean daily doses in milligrams per kilogram of body weight were 4.2 ± 1.3 and 2.4 ± 0.73 of colistin base activity and PMB, respectively. The overall incidence of RF was 16.9% (83 patients): 38.3% and 12.7% in the CMS and PMB groups, respectively (P< 0.001). In multivariate analysis, CMS therapy was an independent risk factor for RF (hazard ratio, 3.35; 95% confidence interval, 2.05 to 5.48;P< 0.001) along with intensive care unit admission, higher weight, older age, and bloodstream and intraabdominal infections. CMS was also independently associated with a higher risk of RF in various subgroup analyses. The incidence of RF was higher in the CMS group regardless of the patient baseline creatinine clearance. The development of RF during therapy was not associated with 30-day mortality in multivariate analysis. CMS was associated with significantly higher rates of RF than those of PMB. Further studies are required to confirm our findings in other patient populations.
authors: Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil Infectious Diseases Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
authors: Maria Helena
authors: MH
authors: Rigatto
authors: Department of Infection Control, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Department of Infectious Diseases, Laboratório de Investigação Médica, LIM 54, and Instituto de Medicina Tropical, University of São Paulo, São Paulo, Brazil.
authors: Maura S
authors: MS
authors: Oliveira
authors: Department of Infection Control, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Department of Infectious Diseases, Laboratório de Investigação Médica, LIM 54, and Instituto de Medicina Tropical, University of São Paulo, São Paulo, Brazil.
authors: Lauro V
authors: LV
authors: Perdigão-Neto
authors: Department of Infection Control, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Department of Infectious Diseases, Laboratório de Investigação Médica, LIM 54, and Instituto de Medicina Tropical, University of São Paulo, São Paulo, Brazil.
authors: Anna S
authors: AS
authors: Levin
authors: Intensive Care Unit, Universidade Estadual de Londrina, Londrina, Brazil.
authors: Claudia M
authors: CM
authors: Carrilho
authors: Intensive Care Unit, Universidade Estadual de Londrina, Londrina, Brazil.
authors: Marcos Toshiyuki
authors: MT
authors: Tanita
authors: Infectious Diseases Service, Universidade Federal de Curitiba, Curitiba, Brazil.
authors: Felipe F
authors: FF
authors: Tuon
authors: Infectious Diseases Service, Universidade Federal de Curitiba, Curitiba, Brazil.
authors: Douglas E
authors: DE
authors: Cardoso
authors: Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Natane T
authors: NT
authors: Lopes
authors: Infectious Diseases Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil Infection Control Service, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil.
authors: Diego R
authors: http://orcid.org/0000-0002-8683-3833
authors: DR
authors: Falci
authors: Infectious Diseases Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil azavascki@hcpa.edu.br.
authors: Alexandre P
authors: AP
authors: Zavascki
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001835:Body Weight; D003091:Colistin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D004334:Drug Administration Schedule; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000254:growth & development / Q000472:pathogenicity; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D006801:Humans; D007362:Intensive Care Units; D059413:Intraabdominal Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000188:drug therapy / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011112:Polymyxin B / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents; C004691:colistinmethanesulfonic acid; D011112:Polymyxin B; D003091:Colistin