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Polymyxin B-Associated Nephrotoxicity and Its Predictors: A Retrospective Study in Carbapenem-Resistant Gram-Negative

Xiao-Li Wu1,2, Wen-Ming Long3, Qiong Lu1

  • 1Department of Pharmacy, The Second Xiangya Hospital, Institute of Clinical Pharmacy, Central South University, Changsha, China.

Frontiers in Pharmacology
|May 16, 2022
PubMed

Insights

Polymyxin B (PMB) can cause acute kidney injury (AKI) in patients with carbapenem-resistant Gram-negative bacterial infections. Male sex, digestive diseases, furosemide use, and higher baseline serum creatinine are key risk factors for AKI.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Polymyxin B (PMB) is crucial for treating carbapenem-resistant Gram-negative bacterial (CR-GNB) infections.
  • Nephrotoxicity and neurotoxicity are significant adverse effects limiting PMB's clinical application.

Purpose of the Study:

  • To investigate the incidence of PMB-associated nephrotoxicity.
  • To identify predictors of acute kidney injury (AKI) in patients receiving PMB.

Main Methods:

  • Retrospective analysis of 234 patients with CR-GNB infections treated with intravenous PMB for over 72 hours.
  • Assessment of AKI using serum creatinine variations based on RIFLE criteria.
  • Univariate and binary logistic regression analyses to identify risk factors for AKI.

Main Results:

  • 67 out of 234 patients (28.63%) developed AKI.
  • Independent risk factors for AKI included male sex (OR=3.237), digestive system diseases (OR=2.481), furosemide use >20 mg/day (OR=2.473), and higher baseline serum creatinine (OR=0.994).
  • PMB maintenance dose was associated with AKI severity (p < 0.05).

Conclusions:

  • Male sex, digestive diseases, furosemide use, and elevated baseline serum creatinine are independent risk factors for PMB-associated AKI.
  • The maintenance dose of PMB may influence AKI severity.
  • Close serum creatinine monitoring is recommended during PMB therapy.
Keywords:
acute kidney injuryadverse reactionscarbapenem-resistant Gram-negative bacterianephrotoxicitypolymyxin B

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