| Autor: |
Phe, Kady, Lee, Yuman, McDaneld, Patrick M., Prasad, Nishant, Yin, Taijun, Figueroa, Deborah A., Musick, William L., Cottreau, Jessica M., Hu, Ming, Tam, Vincent H. |
| Zdroj: |
Antimicrobial Agents and Chemotherapy; February 2014, Vol. 58 Issue: 5 p2740-2746, 7p |
| Abstrakt: |
ABSTRACTDespite concerns of nephrotoxicity, polymyxin antibiotics often remain the only susceptible agents for multidrug-resistant (MDR) Gram-negative bacteria. Colistin has been more commonly used clinically due to a perceived safety benefit. We compared the nephrotoxicity of colistin to polymyxin B. The in vitrocytotoxicity of colistin was compared to polymyxin B in two mammalian renal cell lines. To validate the clinical relevance of the findings, we evaluated adult patients with normal renal function who received a minimum of 72 h of polymyxin therapy in a multicenter study. The primary outcome was the prevalence of nephrotoxicity, as defined by the RIFLE (risk, injury, failure, loss, end-stage kidney disease) criteria. Colistin exhibited an in vitrocytotoxicity profile similar to polymyxin B. A total of 225 patients (121 receiving colistimethate, 104 receiving polymyxin B) were evaluated. Independent risk factors for colistimethate-associated nephrotoxicity included age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.00 to 1.07; P= 0.03), duration of therapy (OR 1.08; 95% CI, 1.02 to 1.15; P= 0.02), and daily dose by ideal body weight (OR 1.40; 95% CI, 1.05 to 1.88; P= 0.02). In contrast, cystic fibrosis was found to be a protective factor in patients who received colistimethate (OR, 0.03; 95% CI, 0.001 to 0.79; P= 0.04). In a matched analysis based on the risk factors identified (n= 76), the prevalence of nephrotoxicity was higher with colistimethate than with polymyxin B (55.3% versus 21.1%; P= 0.004). Polymyxin B was not found to be more nephrotoxic than colistin and may be the preferred polymyxin for MDR infections. A prospective study comparing the two polymyxins directly is warranted. |
| Databáze: |
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