Colistin-induced Nephrotoxicity: Experience from a University Hospital

Abstract

Introduction: Colistin has been widely used in the treatment of infections caused by multidrug-resistant bacteria. This study aimed to determine the frequency and risk factors of colistin-related nephrotoxicity. Materials and Methods: Patients who received colistin between October 2018 and August 2019 in a tertiary care hospital were analyzed retrospectively. Kidney Disease Improving Global Outcome criteria were used for the staging of nephrotoxicity. Results: A total of 100 patients who were treated with colistin were included in this study. The median patient age was 64 years, and 43% were female. Nephrotoxicity was detected in 52% of patients at Week 1 of colistin therapy, and 59% of the patients on colistin therapy experienced nephrotoxicity at any time. Serum creatinine increased to ≥1.5 times the baseline in a median of four (1-11) days, and the estimated glomerular filtration rate decreased below 60 ml/min in a median of five (1-42) days. After Week 1 of colistin therapy, 48% of the patients preserved “normal” kidney functions. Of the patients who experienced nephrotoxicity in Week 1 of colistin therapy: 85% had stage 1, 56% had stage 2, and 35% had stage 3. The length of hospitalization [Odds ratio (OR): 1.009, 95% confidence interval (CI): 1.001-1.017], age (OR: 1.036, 95% CI: 1.005-1.068), duration of colistin therapy (OR: 1.115, 95% CI: 1.023-1.216), and use of vasopressors (OR: 3.012, 95% CI: 1.003-9.042) were significantly associated with nephrotoxicity at any time during colistin therapy. Conclusion: This study showed a high rate of colistin-related nephrotoxicity. Regular monitoring of renal functions, appropriate dosing, and limiting the duration of colistin therapy as much as possible may be useful to avoid nephrotoxicity in older patients particularly when administered with vasopressors.

Keywords

• polymyxins
• acute kidney injury
• nephrotoxicity
• risk factor
• colistin dosage