Acute kidney injury during colistin therapy: a prospective study in patients with extensively-drug resistant Acinetobacter baumannii infections.
Clin Microbiol Infect. 2016 Aug 18;
Authors: Durante-Mangoni E, Andini R, Signoriello S, Cavezza G, Murino P, Buono S, De Cristofaro M, Taglialatela C, Bassetti M, Malacarne P, Petrosillo N, Corcione A, Viscoli C, Utili R, Gallo C
Abstract
OBJECTIVES: To prospectively assess incidence and risk factors for colistin-associated nephrotoxicity.
METHODS: This is a secondary analysis of a multicentre, randomised clinical trial, comparing efficacy and safety of colistin versus the combination of colistin plus rifampicin in severe infections due to XDR Acinetobacter baumannii. The primary end point was Acute Kidney Injury (AKI) during colistin treatment, assessed using the AKI Network Criteria, and considering death as a competing risk. One hundred and sixty-six adult patients without baseline kidney disease on renal replacement therapy were studied. All had life-threatening infections due to colistin-susceptible XDR A.baumannii. Patients received colistin intravenously at the same initial dose (2 MU every 8 hours) with predefined dose adjustments according to the actual renal function. Serum creatinine was measured at baseline and at days 4, 7, 11, 14 and 21 (or last day of therapy when discontinued earlier). Outcomes assessed were 'time to any kidney injury' (AKI stages 1-3) and 'time to severe kidney injury' (considering only AKI stages 2-3 as events). Death was accounted for as a competing event. When evaluating overall mortality, AKI occurrence was modelled as a time-dependent variable.
RESULTS: AKI was observed in 84 patients (50.6%, stage 1 in 40.4%), with an incidence rate of 5/100 person-days (95%C.I. 4-6.2). Risk estimates of AKI at 7 and 14 days were 30.6% and 58.8%. Age and prior chronic kidney disease were significantly associated with any AKI in multivariable analysis. Neither 'any' nor 'severe AKI' were associated with on -treatment mortality (p=0.32 and 0.54, respectively).
CONCLUSIONS: AKI occurs in a third to a half of colistin treated patients and is more likely in elderly, and kidney disease subjects. As no impact of colistin-associated AKI on mortality was found, this adverse event should not represent a reason for withholding colistin therapy, whenever indicated.
PMID: 27545697 [PubMed - as supplied by publisher]