Risk factors for acute kidney injury in patients treated with polymyxin B or colistin methanesulfonate sodium

• Published in: International journal of antimicrobial agents Vol. 43; no. 4; pp. 349 - 352
• Main Authors: Tuon, Felipe F, Rigatto, Maria Helena, Lopes, Cesar K, Kamei, Letícia K, Rocha, Jaime L, Zavascki, Alexandre P
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-04-2014
• Subjects: Acinetobacter baumannii - drug effects; Acinetobacter baumannii - pathogenicity; Acinetobacter Infections - drug therapy; Acute kidney injury; Acute Kidney Injury - chemically induced; Acute Kidney Injury - epidemiology; Acute Kidney Injury - mortality; Acute Kidney Injury Network; Acute renal failure; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Cohort Studies; Cohort study; Colistin; Colistin - adverse effects; Colistin - analogs & derivatives; Colistin - therapeutic use; Creatinine; Female; Hospital Mortality; Humans; Infectious Disease; Klebsiella Infections - drug therapy; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - pathogenicity; Male; Middle Aged; Polymyxin; Polymyxin B - adverse effects; Polymyxin B - therapeutic use; Pseudomonas aeruginosa - drug effects; Pseudomonas aeruginosa - pathogenicity; Pseudomonas Infections - drug therapy; Retrospective Studies; Risk Factors; Vancomycin - adverse effects; Vancomycin - therapeutic use; Creatinine; Acute Kidney Injury Network; Colistin; Acute kidney injury; Cohort study; Polymyxin; Acute renal failure
• DOI: 10.1016/j.ijantimicag.2013.12.002
• EISSN: 1872-7913
• ISSN: 0924-8579

Abstract Polymyxin B (PMB) and colistin, administered as the prodrug colistin methanesulfonate sodium (CMS), are increasingly used to treat carbapenem-resistant Gram-negative bacteria. Nephrotoxicity is the major dose-limiting adverse effect of both polymyxins. A retrospective cohort study of 132 patients was conducted to evaluate risk factors for acute kidney injury (AKI), classified according to Acute Kidney Injury Network criteria, in patients treated with ≥48 h of intravenous PMB or CMS, with particular focus on potential differences between each polymyxin. The overall incidence of AKI was 25.8% (34/132) [20.8% (20/96) and 38.9% (14/36) in patients treated with PMB and CMS, respectively; P = 0.06]. In the Cox regression model, doses ≥2 million International Units (MIU) of PMB or >9 MIU of CMS were the only variable independently associated with AKI [adjusted hazard ratio (aHR) = 2.11, 95% confidence interval (CI) 1.01–4.41; P = 0.04]. Vancomycin co-administration was strongly associated with AKI, although this was not statistically significant (aHR = 2.22, 95% CI 0.98–5.04; P = 0.058). There was no statistically significant difference in the incidence of AKI between patients treated with PMB or CMS in the multivariate model (aHR = 1.74, 95% CI 0.82–3.69; P = 0.15). High dose was the main risk factor for AKI regardless of the polymyxin administered. Vancomycin co-administration likely increases the risk of AKI. Although there was a higher overall incidence of AKI in patients treated with CMS compared with PMB, CMS was not significantly associated with this outcome after adjusting for the above variables.