Predicting the risk of nephrotoxicity in patients receiving colistimethate sodium: a multicentre, retrospective, cohort study.

Autor:	Phe K; Department of Pharmacy, Baylor St Luke's Medical Center, Houston, TX, USA., Shields RK; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA., Tverdek FP; Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Aitken SL; Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Guervil DJ; Department of Pharmacy, Memorial Hermann-Texas Medical Center, Houston, TX, USA., Lam WM; Department of Pharmacy, University of Texas Medical Branch, Galveston, TX, USA., Musgrove RJ; Department of Pharmacy, Harris Health System, Houston, TX, USA., Luce AM; Department of Pharmacy, Texas A&M Health Science Center, Houston, TX, USA., Tam VH; Department of Pharmacy, Baylor St Luke's Medical Center, Houston, TX, USA vtam@uh.edu.; Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2016 Dec; Vol. 71 (12), pp. 3585-3587. Date of Electronic Publication: 2016 Aug 19.
DOI:	10.1093/jac/dkw329
Abstrakt:	Objectives: With increasing rates of infections caused by MDR Gram-negative organisms, clinicians resort to older agents such as colistimethate sodium (CMS) despite a significant risk of nephrotoxicity. Several risk factors for CMS-associated nephrotoxicity have been reported, but they have yet to be validated. We compared the performance of published mathematical models in predicting the risk of CMS-associated nephrotoxicity. Methods: In a multicentre, retrospective, cohort study, adult patients (≥18 years of age) were evaluated from five large academic medical centres in the USA. Patients with normal renal function (baseline serum creatinine ≤1.5 mg/dL) who received intravenous CMS for ≥72 h were followed for up to 30 days. The development of nephrotoxicity was as defined by the RIFLE criteria. Each published model was conditioned using patient-specific variables to predict the risk of nephrotoxicity. The predictive performance of the models was evaluated using the observed-to-expected (O/E) ratio. The most significant cut-off threshold for stratifying patients into high and low risk of nephrotoxicity was identified using classification and regression tree analysis. Results: A total of 106 patients were examined (mean age 53.3 ± 14.9 years, 66% male); the overall observed nephrotoxicity rate was 52.8%. We identified a simple model demonstrating reasonable overall nephrotoxicity risk assessment [O/E ratio of 1.07 (95% CI = 0.81-1.39)] and high sensitivity (92.9%) in predicting nephrotoxicity development in patients on CMS therapy. Conclusions: We identified a model that could be incorporated into patient management strategies to reduce the risk of nephrotoxicity in patients requiring CMS therapy. (© The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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