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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• 作者：Monica Rocco (1)
  Luca Montini (2)
  Elisa Alessandri (1)
  Mario Venditti (3)
  Amalia Laderchi (1)
  Pascale De Gennaro (2)
  Giammarco Raponi (3)
  Michela Vitale (1)
  Paolo Pietropaoli (1)
  Massimo Antonelli (2)
  
• 刊名：Critical Care
• 出版年：2013
• 出版时间：August 2013
• 年：2013
• 卷：17
• 期：4
• 全文大小：
• 作者单位：Monica Rocco (1)
  Luca Montini (2)
  Elisa Alessandri (1)
  Mario Venditti (3)
  Amalia Laderchi (1)
  Pascale De Gennaro (2)
  Giammarco Raponi (3)
  Michela Vitale (1)
  Paolo Pietropaoli (1)
  Massimo Antonelli (2)
  
  1. Anesthesiology and Intensive Care, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
  2. Anesthesiology and Intensive Care, Catholic University of the Sacred Heart, Largo Agostino Gemelli 8, 00168, Rome, Italy
  3. Department of Public Health Sciences and Infectious Diseases, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
  
• ISSN：1364-8535

文摘

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 two general ICUs in teaching hospitals between 1 April 2009 and 30 June 2011 with 1) no evidence on admission of acute or chronic kidney disease; and 2) treatment for more than seven days with CMS and/or other nephrotoxic antimicrobials (NAs, that is, 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 II (SAPS II) scores 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 scores ≥43. Similar results were obtained in the 222 patients treated with CMS alone or NAs alone. Conclusions In severely ill ICU patients without pre-existing renal disease who receive CMS high-dose for more than seven 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 score.