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.

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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 Aug 14;17(4):R174

Authors: Rocco M, Montini L, Alessandri E, Venditti M, Laderchi A, De Pascale G, Raponi G, Vitale M, Pietropaoli P, Antonelli M

Abstract
INTRODUCTION: Use of colistin methanesulfonate (CMS) was abandoned in the 1970s because of excessive nephrotoxicity, but it has been reintroduced as a last-resort treatment for extensively drug-resistant infections caused by gram-negative bacteria (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumonia). We conducted a retrospective cohort study to evaluate risk factors for new-onset acute kidney injury (AKI) in critically ill patients receiving high intravenous doses of colistin methanesulfonate and/or other nephrotoxic antibiotics.
METHODS: The cohort consisted of 279 adults admitted to 2 general ICUs in teaching hospitals between April 1, 2009 and June 30, 2011 with 1) no evidence on admission of acute or chronic kidney disease; 2) treatment for > 7 days with CMS and/or other nephrotoxic antimicrobials (NAs, i.e., aminoglycosides, glycopeptides). Logistic regression analysis was used to identify risk factors associated with this outcome.
RESULTS: The 279 cases that met the inclusion criteria included 147 patients treated with CMS, alone (n=90) or with NAs (n=57), and 132 treated with NAs alone. The 111 (40%) who developed AKI were significantly older and had significantly higher Simplified Acute Physiology Score Two (SAPS II) than those who did not develop AKI, but rates of hypertension, diabetes mellitus, and congestive heart failure were similar in the two groups. The final logistic regression model showed that in the 147 patients who received CMS alone or with NAs, onset of AKI during the ICU stay was associated with septic shock and with SAPS II [greater than or equal to] 43. Similar results were obtained in the 222 patients treated with CMS alone or NAs alone.
CONCLUSION: In severely ill ICU patients without pre-existing renal disease who receive CMS high-dose for > 7 days, CMS therapy does not appear to be a risk factor for this outcome. Instead, the development of AKI was strongly correlated with the presence of septic shock and with the severity of the patients as reflected by the SAPS II.

PMID: 23945197 [PubMed - as supplied by publisher]

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