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Risk factors for nephrotoxicity onset associated with polymyxin B therapy

Yanina Dubrovskaya1, Nishant Prasad2, Yuman Lee3

  • 1Department of Pharmacy, New York University Langone Medical Center, New York, NY, USA.

The Journal of Antimicrobial Chemotherapy
|February 6, 2015
PubMed
Abstract

Insights

Polymyxin B, effective against multidrug-resistant Gram-negative bacteria, carries a risk of nephrotoxicity. Key risk factors identified include higher daily doses, vancomycin co-administration, and contrast media use, aiding in optimizing treatment strategies.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Polymyxin B is crucial for treating multidrug-resistant (MDR) Gram-negative bacterial infections.
  • Nephrotoxicity is a significant limitation impacting Polymyxin B's clinical utility.
  • Identifying risk factors is essential for safe and effective Polymyxin B administration.

Purpose of the Study:

  • To determine the independent risk factors associated with the onset of nephrotoxicity during Polymyxin B therapy.
  • To provide data for optimizing Polymyxin B dosing and co-administration strategies.
  • To enhance the safe use of Polymyxin B in clinical practice.

Main Methods:

  • A multicentre, retrospective cohort study involving adult patients with normal renal function receiving Polymyxin B for at least 72 hours.
  • Data collected from medical records, with patients followed for up to 30 days post-therapy initiation.
  • Statistical analysis using a Cox proportional hazards model to identify risk factors for nephrotoxicity onset.

Main Results:

  • The study evaluated 192 patients; 45.8% experienced nephrotoxicity, with a median onset at 9 days.
  • Independent risk factors for nephrotoxicity included higher daily doses of Polymyxin B (HR=1.73), concurrent vancomycin use (HR=1.89), and contrast media exposure (HR=1.79).
  • Nephrotoxicity occurred earlier in patients identified as high-risk (P=0.003).

Conclusions:

  • Several key risk factors for Polymyxin B-induced nephrotoxicity have been identified.
  • These findings, combined with pharmacokinetic/pharmacodynamic data, can guide the optimization of Polymyxin B treatment regimens.
  • The study contributes to safer and more effective management of MDR Gram-negative infections.
Keywords:
MDR Gram-negative infectionsmodelnephrotoxic

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