title: Polymyxin-B and vancomycin-associated acute kidney injury in critically ill patients.
abstract: BACKGROUND
  This study aims to investigate renal toxicities of Polymyxin B and Vancomycin among critically ill patients and risk factors for acute kidney injury (AKI).
  
  
  METHODS
  This is a cross-sectional study conducted with patients admitted to an intensive care unit (ICU) of a tertiary hospital in Brazil. Patients were divided into two groups: those who used association of Polymyxin B + Vancomycin (Group I) and those who used only Polymyxin B (Group II). Risk factors for AKI were also analyzed.
  
  
  RESULTS
  A total of 115 patients were included. Mean age was 59.2 ± 16.1 years, and 52.2% were males. Group I presented higher GFR (117.1 ± 70.5 vs. 91.5 ± 50 ml/min/1.73 m², p = 0.02) as well as lower creatinine (0.9 ± 0.82 vs. 1.0 ± 0.59 mg/dL, p = 0.014) and urea (51.8 ± 23.7 vs. 94.5 ± 4.9 mg/dL, p = 0.006) than group II on admission. Group I also manifested significantly higher incidence of AKI than group II (62.7% vs. 28.5%, p = 0.005), even when stratified according to RIFLE criteria ('Risk' 33.9% vs. 10.7%; 'Injury' 10.2% vs. 8.9%; 'Failure' 18.6% vs. 8.9%; p = 0.03). Accumulated Polymyxin B dose > 10 million IU was an independent predictor for AKI (OR = 2.72, 95% CI = 1.13-6.51, p = 0.024).
  
  
  CONCLUSIONS
  Although patients who received Polymyxin B plus vancomycin had more favorable clinical profile and higher previous GFR, they presented a higher AKI incidence than those patients who received Polymyxin B alone. Cumulative Polymyxin B dose > 10 million IU was independently associated to AKI.
authors.affiliation: a Department of Internal Medicine, School of Medicine, Post-Graduation Program in Medical Sciences , Federal University of Ceará , Fortaleza , Brazil.
authors.forename: Douglas de Sousa
authors.initials: DS
authors.lastname: Soares
authors.affiliation: b Division of Nephrology , Fortaleza General Hospital , Fortaleza , Brazil.
authors.forename: André da Fonte
authors.initials: ADF
authors.lastname: Reis
authors.affiliation: c School of Medicine, Post-Graduation Program in Collective Health, Health Sciences Center , University of Fortaleza , Fortaleza , Brazil.
authors.forename: Geraldo Bezerra da
authors.initials: GBD
authors.lastname: Silva Junior
authors.affiliation: a Department of Internal Medicine, School of Medicine, Post-Graduation Program in Medical Sciences , Federal University of Ceará , Fortaleza , Brazil.
authors.forename: Tacyano Tavares
authors.initials: TT
authors.lastname: Leite
authors.affiliation: a Department of Internal Medicine, School of Medicine, Post-Graduation Program in Medical Sciences , Federal University of Ceará , Fortaleza , Brazil.
authors.forename: Sérgio Luiz Arruda
authors.initials: SLA
authors.lastname: Parente Filho
authors.affiliation: a Department of Internal Medicine, School of Medicine, Post-Graduation Program in Medical Sciences , Federal University of Ceará , Fortaleza , Brazil.
authors.forename: Carina Vieira de Oliveira
authors.initials: CVO
authors.lastname: Rocha
authors.affiliation: a Department of Internal Medicine, School of Medicine, Post-Graduation Program in Medical Sciences , Federal University of Ceará , Fortaleza , Brazil.|b Division of Nephrology , Fortaleza General Hospital , Fortaleza , Brazil.
authors.forename: Elizabeth De Francesco
authors.initials: EF
authors.lastname: Daher
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001938:Brazil / Q000453:epidemiology; D016638:Critical Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000009:adverse effects*; D012307:Risk Factors; D014640:Vancomycin / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin; D011112:Polymyxin B
keywords: Polymyxin B; acute kidney injury; drug toxicity; vancomycin