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Comprehensive Assessment of Colistin Induced Nephrotoxicity: Incidence, Risk Factors and Time Course
Razan Rabi1, Ahmad Enaya1, Mamoun W Sweileh1
1Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine.
Infection and Drug Resistance
|May 22, 2023
Summary
Colistin use, driven by multidrug-resistant organisms, frequently causes nephrotoxicity, especially in heavier patients. Combining colistin with carbapenems may offer protection against kidney injury.
Area of Science:
- Pharmacology and Nephrology
- Infectious Diseases and Critical Care Medicine
Background:
- The rise of multidrug-resistant (MDR) microorganisms has led to the re-emergence of colistin use.
- Colistin's previous abandonment was due to adverse effects, particularly nephrotoxicity.
- The incidence of colistin-induced nephrotoxicity varies across different patient populations.
Purpose of the Study:
- To determine the incidence of colistin-associated nephrotoxicity.
- To identify risk factors associated with colistin-induced nephrotoxicity.
Main Methods:
- A retrospective study of 178 patients receiving colistin for over 48 hours between 2019-2022.
- Data collected included demographic and clinical information, with a 14-day follow-up post-colistin initiation.
- Logistic regression analysis was employed to identify risk factors for nephrotoxicity.
Main Results:
- The incidence of nephrotoxicity was 44.9%, with overall mortality at 33%.
- Higher patient weight (OR=1.1) was a significant risk factor for nephrotoxicity.
- Combination therapy with carbapenems demonstrated a protective effect (OR=0.09).
- Nephrotoxicity severity (KDIGO stages 1-3) correlated with earlier acute kidney injury (AKI) onset, reduced recovery, and higher colistin doses.
Conclusions:
- Colistin-induced nephrotoxicity is a significant concern, particularly in patients with higher body weight.
- Carbapenem combination therapy may mitigate the risk of colistin-induced nephrotoxicity.
- Higher colistin doses and early AKI onset are associated with increased severity and potential need for dialysis.
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