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Risks of Polymyxin B Nephrotoxicity and Its Precursors in the Intensive Care Unit: A Retrospective Cohort Study

Hüseyin Özkarakaş1, Yeliz Özdemir2, Selma Tosun2

  • 1Intensive Care Unit, University of Health Sciences Izmir Bozyaka Training and Research Hospital, Izmir, TUR.

Cureus
|October 2, 2023
PubMed
Abstract

Insights

Polymyxin B caused kidney injury in 35% of critically ill patients. Advanced age, high BMI, and longer duration of use are key risk factors for nephrotoxicity.

Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Infectious Diseases

Background:

  • Polymyxin antibiotics are crucial for treating multidrug-resistant gram-negative infections.
  • Nephrotoxicity is a significant limitation of polymyxin use, necessitating further investigation.
  • Understanding polymyxin B's renal impact is vital for optimizing patient care.

Purpose of the Study:

  • To evaluate the incidence of nephrotoxicity associated with polymyxin B in critically ill patients.
  • To identify independent risk factors contributing to polymyxin B-induced kidney injury.
  • To inform clinical practice regarding safe polymyxin B administration.

Main Methods:

  • Retrospective cohort study of adult ICU patients treated with polymyxin B for ≥72 hours.
  • Exclusion of patients with pre-existing renal failure or acute kidney injury (AKI).
  • Comparison of patient characteristics between groups with and without AKI post-treatment.

Main Results:

  • 35% of patients (21/60) developed nephrotoxicity (NT) after polymyxin B treatment.
  • Statistically significant differences observed in advanced age, low GFR, high creatinine, BMI, comorbidities, and duration of use.
  • Multivariate analysis identified duration of use, BMI, and advanced age as independent risk factors for AKI.

Conclusions:

  • Polymyxin B is associated with a 35% rate of kidney injury in critically ill patients without prior renal issues.
  • Advanced age, elevated BMI, and prolonged polymyxin B exposure are independent predictors of nephrotoxicity.
  • Close renal function monitoring and early intervention are recommended for patients receiving polymyxin B, especially those with identified risk factors.
Keywords:
acute kidney injurycarbapenem resistant gram negative infectioni̇ntensive care unitnephrotoxicitypolymyxin-bsepsis

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