Trough colistin plasma level is an independent risk factor for nephrotoxicity : A prospective observational cohort study
Sorlí, Luisa (Parc de Salut MAR de Barcelona)
Luque, Sonia (Parc de Salut MAR de Barcelona)
Grau, Santiago (Parc de Salut MAR de Barcelona)
Berenguer, Núria (Parc de Salut MAR de Barcelona)
Segura, Concepción (Laboratori de Referència de Catalunya (El Prat de Llobregat, Catalunya))
Montero, María Milagro (Parc de Salut MAR de Barcelona)
Álvarez Lerma, Francisco (Parc de Salut MAR de Barcelona)
Knobel Freud, Hernando (Parc de Salut MAR de Barcelona)
Benito, Natividad (Institut d'Investigació Biomèdica Sant Pau)
Horcajada, Juan Pablo (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2013
Resum:	Background: Data regarding the most efficacious and least toxic schedules for the use of colistin are scarce. The aim of this study was to determine the incidence and the potential risk factors of colistin-associated nephrotoxicity including colistin plasma levels. Methods: A prospective observational cohort study was conducted for over one year in patients receiving intravenous colistin methanesulfonate sodium (CMS). Blood samples for colistin plasma levels were collected immediately before (C) and 30 minutes after CMS infusion (C). Renal function was assessed at baseline, on day 7 and at the end of treatment (EOT). Severity of acute kidney injury (AKI) was defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease) criteria. Results: One hundred and two patients met the inclusion criteria. AKI related to CMS treatment on day 7 and at the end of treatment (EOT) was observed in 26 (25. 5%) and 50 (49. 0%) patients, respectively. At day 7, C (OR, 4. 63 [2. 33-9. 20]; P < 0. 001) was the only independent predictor of AKI. At EOT, the Charlson score (OR 1. 26 [1. 01-1. 57]; P = 0. 036), C (OR 2. 14 [1. 33-3. 42]; P = 0. 002), and concomitant treatment with ≥ 2 nephrotoxic drugs (OR 2. 61 [1. 0-6. 8]; P = 0. 049) were independent risk factors for AKI. When C was evaluated as a categorical variable, the breakpoints that better predicted AKI were 3. 33 mg/L (P < 0. 001) on day 7 and 2. 42 mg/L (P < 0. 001) at EOT. Conclusions: When using the RIFLE criteria, colistin-related nephrotoxicity is observed in a high percentage of patients. C levels are predictive of AKI. Patients who receive intravenous colistin should be closely monitored and C might be a new useful tool to predict AKI. © 2013 Sorlí et al. ; licensee BioMed Central Ltd.
Ajuts:	Ministerio de Ciencia e Innovación PS09/01634
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Colistin ; Colistin plasma levels ; Nephrotoxicity risk factors ; RIFLE criteria
Publicat a:	BMC Infectious diseases, Vol. 13 Núm. 1 (19 2013) , p. 380, ISSN 1471-2334

DOI: 10.1186/1471-2334-13-380
PMID: 23957376

9 p, 210.5 KB

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