Advertisement

International Journal of Clinical Pharmacy

, Volume 40, Issue 2, pp 444–449 | Cite as

Incidence and risk factors of nephrotoxicity in patients on colistimethate sodium

  • Moataz M. Hassan
  • Zied Gaifer
  • Ibrahim S. Al-Zakwani
Research Article

Abstract

Background Colistin is used to treat gram-negative infections but it’s highly associated with nephrotoxicity. Objectives To determine the incidence and risk factors as well as mortality in patients on colistin. Setting Sultan Qaboos University Hospital, Muscat, Oman. Methods This was a retrospective cohort study of patients admitted and who received colistin for ≥ 48 h. The exclusion criteria included inhaled colistin therapy, cystic fibrosis, or pregnancy. The study period was from January 2010 to June 2016. Main outcome measures Nephrotoxicity using the Risk, Injury, Failure, Loss and Endstage kidney disease (RIFLE) criteria. The secondary outcomes were incidence, risk factors and mortality in patients on colistin. Results A total of 123 patients were included. Colistin-associated nephrotoxicity (CAN) occurred in 57 (46%) patients after colistin therapy. As per the RIFLE criteria, 22 (18%) patients were classified as ‘at risk’, 17 (14%) as ‘injury’, and 18 (15%) as ‘failure’. Multivariate analysis indicated that increasing age (adjusted odds ratio (aOR), 1.03; 95% confidence interval (CI) 1.01–1.06; p = 0.004) and higher APACHE II score (aOR 1.08; 95% CI 1.01–1.16; p = 0.040) were significant predictors for the development of nephrotoxicity. Factors associated with mortality included ICU admission (aOR 23.3; 95% CI 5.04–106; p < 0.001), vasopressin use (aOR 5.54; 95% CI 1.56–19.6; p = 0.008) and higher APACHE II score (aOR 1.15; 95% CI 1.03–1.30; p = 0.027). Conclusions The incidence of CAN was 46%. Increasing age and higher APACHE II score were the risk factors for CAN. Factors associated with mortality at 28 days included ICU admission and higher APACHE II score.

Keywords

Colistimethate sodium Colistin Gram-negative bacteria Nephrotoxicity Oman 

Notes

Acknowledgements

The authors would like to thank the patients, physicians, nurses and other support staff for their invaluable cooperation in this study.

Funding

This study received no external funding.

Conflicts of interest

The authors declare no conflicts of interest with respect to the authorship and/or publication of this article.

References

  1. 1.
    Balkan II, Dogan M, Durdu B, Batirel A, Hakyemez IN, Cetin B, et al. Colistin nephrotoxicity increases with age. Scand J Infect Dis. 2014;46:678–85.CrossRefPubMedGoogle Scholar
  2. 2.
    Binh NG, Hayakawa K, Co DX, Tuan ND, Anh NH, Thuy NT, et al. The efficacy and nephrotoxicity associated with colistin use in an intensive care unit in Vietnam: use of colistin in a population of lower body weight. Int J Infect Dis. 2015;35:18–23.CrossRefPubMedGoogle Scholar
  3. 3.
    Nazer LH, Rihani S, Hawari FI, Le J. High-dose colistin for microbiologically documented serious respiratory infections associated with carbapenem-resistant Acinetobacter baummannii in critically ill cancer patients: a retrospective cohort study. Infect Dis (Lond). 2015;47:755–60.CrossRefGoogle Scholar
  4. 4.
    Rigatto MH, Oliveira MS, Perdigão-Neto LV, Levin AS, Carrilho CM, Tanita MT, et al. Multicenter prospective cohort study of renal failure in patients treated with colistin versus polymyxin B. Antimicrob Agents Chemother. 2016;60:2443–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Rocco M, Montini L, Alessandri E, Venditti M, Laderchi A, De Pascale G, et al. Risk factors for acute kidney injury in critically ill patients receiving high intravenous doses of colistin methanesulfonate and/or other nephrotoxic antibiotics: a retrospective cohort study. Crit Care. 2013;17:R174.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pogue JM, Lee J, Marchaim D, Yee V, Zhao JJ, Chopra T, et al. Incidence of and risk factors for colistin-associated nephrotoxicity in a large academic health system. Clin Infect Dis. 2011;53:879–84.CrossRefPubMedGoogle Scholar
  7. 7.
    Hartzell JD, Neff R, Ake J, Howard R, Olson S, Paolino K, et al. Nephrotoxicity associated with intravenous colistin (colistimethate sodium) treatment at a tertiary care medical center. Clin Infect Dis. 2009;48:1724–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Temocin F, Erdinc S, Tulek N, Demirelli M, Bulut C, Ertem G. Incidence and risk factors for colistin-associated nephrotoxicity. Jpn J Infect Dis. 2015;68:318–20.CrossRefPubMedGoogle Scholar
  9. 9.
    Akajagbor DS, Wilson SL, Shere-Wolfe KD, Dakum P, Charurat ME, Gilliam BL. Higher incidence of acute kidney injury with intravenous colistimethate sodium compared with polymyxin B in critically ill patients at a tertiary care medical center. Clin Infect Dis. 2013;57:1300–3.CrossRefPubMedGoogle Scholar
  10. 10.
    Omrani AS, Alfahad WA, Shoukri MM, Baadani AM, Aldalbahi S, Almitwazi AA, et al. High dose intravenous colistin methanesulfonate therapy is associated with high rates of nephrotoxicity; a prospective cohort study from Saudi Arabia. Ann Clin Microbiol Antimicrob. 2015;14:3.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Pike M, Saltiel E. Colistin- and polymyxin-induced nephrotoxicity: focus on literature utilizing the RIFLE classification scheme of acute kidney injury. J Pharm Pract. 2014;27:554–61.CrossRefPubMedGoogle Scholar
  12. 12.
    Ordooei Javan A, Shokouhi S, Sahraei Z. A review on colistin nephrotoxicity. Eur J Clin Pharmacol. 2015;71:801–10.CrossRefPubMedGoogle Scholar
  13. 13.
    Rattanaumpawan P, Ungprasert P, Thamlikitkul V. Risk factors for colistin-associated nephrotoxicity. J Infect. 2011;62:187–90.CrossRefPubMedGoogle Scholar
  14. 14.
    Balkhair A, Al-Farsi YM, Al-Muharrmi Z, Al-Rashdi R, Al-Jabri M, Neilson F, et al. Epidemiology of multi-drug resistant organisms in a teaching hospital in Oman: a one-year hospital-based study. Sci World J. 2014;2014:157102.CrossRefGoogle Scholar
  15. 15.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefPubMedGoogle Scholar
  16. 16.
    LeGall JR, Loirat P, Alpérovitch A. APACHE II—a severity of disease classification system. Crit Care Med. 1986;14:754–5.PubMedGoogle Scholar
  17. 17.
    Bone RC, Balk RA, Cerra FB, et al. The ACCP/SCCM Consensus Conference Committee; American College of Chest Physicians/Society of Critical Care Medicine. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest. 1992;101:1644–55.CrossRefPubMedGoogle Scholar
  18. 18.
    Lemeshow S, Hosmer DW Jr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. 1982;115:92–106.CrossRefPubMedGoogle Scholar
  19. 19.
    Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143:29–36.CrossRefPubMedGoogle Scholar
  20. 20.
    Kwon JA, Lee JE, Huh W, Peck KR, Kim YG, Kim DJ, et al. Predictors kidney injury associated with intravenous colistin treatment. Int J Antimicrob Agents. 2010;35:473–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Falagas ME, Fragoulis KN, Kasiakou SK, Sermaidis GJ, Michalopoulos A. Nephrotoxicity of intravenous colistin: a prospective evaluation. Int J Antimicrob Agents. 2005;26:504–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Phe K, Lee Y, McDaneld PM, Prasad N, Yin T, Figueroa DA, et al. In vitro assessment and multicenter cohort study of comparative nephrotoxicity rates associated with colistimethate versus polymyxin B therapy. Antimicrob Agents Chemother. 2014;58:2740–6.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Deryke CA, Crawford AJ, Uddin N, Wallace MR. Colistin dosing and nephrotoxicity in a large community teaching hospital. Antimicrob Agents Chemother. 2010;54:4503–5.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Doshi NM, Mount KL, Murphy CV. Nephrotoxicity associated with intravenous colistin in critically ill patients. Pharmacotherapy. 2011;31:1257–64.CrossRefPubMedGoogle Scholar
  25. 25.
    Gauthier TP, Wolowich WR, Reddy A, Cano E, Abbo L, Smith LB. Incidence and predictors of nephrotoxicity associated with intravenous colistin in overweight and obese patients. Antimicrob Agents Chemother. 2012;56:2392–6.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Sorlí L, Luque S, Grau S, Berenguer N, Segura C, Montero MM, et al. Trough colistin plasma level is an independent risk factor for nephrotoxicity: a prospective observational cohort study. BMC Infect Dis. 2013;13:380.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Tumbarello M, Viale P, Viscoli C, Trecarichi EM, Tumietto F, Marchese A, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy. Clin Infect Dis. 2012;55:943–50.CrossRefPubMedGoogle Scholar
  28. 28.
    Metan G, Demiraslan H, Kaynar LG, Zararsız G, Alp E, Eser B. Factors influencing the early mortality in haematological malignancy patients with nosocomial Gram negative bacilli bacteraemia: a retrospective analysis of 154 cases. Braz J Infect Dis. 2013;17:143–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Capone A, Giannella M, Fortini D, Giordano A, Meledandri M, Ballardini M, et al. High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality. Clin Microbiol Infect. 2013;19:E23–30.CrossRefPubMedGoogle Scholar
  30. 30.
    Rigatto MH, Behle TF, Falci DR, Freitas T, Lopes NT, Nunes M, et al. Risk factors for acute kidney injury (AKI) in patients treated with polymyxin B and influence of AKI on mortality: a multicentre prospective cohort study. J Antimicrob Chemother. 2015;70:1552–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Michalopoulos AS, Tsiodras S, Rellos K, Mentzelopoulos S, Falagas ME. Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic. Clin Microbiol Infect. 2005;11:115–21.CrossRefPubMedGoogle Scholar
  32. 32.
    Turkoglu M, Dizbay M, Ciftçi A, Aksakal FN, Aygencel G. Colistin therapy in critically ill patients with chronic renal failure and its effect on development of renal dysfunction. Int J Antimicrob Agents. 2012;39:142–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73:538–46.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Moataz M. Hassan
    • 1
  • Zied Gaifer
    • 2
  • Ibrahim S. Al-Zakwani
    • 1
    • 3
    • 4
  1. 1.Department of PharmacySultan Qaboos University HospitalMuscatOman
  2. 2.Department of MedicineSultan Qaboos University HospitalMuscatOman
  3. 3.Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health SciencesSultan Qaboos UniversityAl-Khoud, MuscatOman
  4. 4.Gulf Health ResearchMuscatOman

Personalised recommendations