중환자에서 Colistimethate 정맥내 투여와 관련된 급성 신손상에 대한 연구
A Study on Acute Kidney Injury Caused by Intravenous Colistimethate in Critically Ill Patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objective: Colistimethate was first became available in 1950s and used until the early 1980s to treat infections causedby gram-negative bacteria and was abandoned due to its nephrotoxicity and neurotoxicity. However, it was recently reintroducedinto the clinical practices due to emergence of multidrug-resistance gram-negative bacteria, particularlyPseudomonas aeruginosa and Acinetobacter baumanii. Therefore, it is increasingly used in the intensive care unit settingsas a salvage therapy. This study was designed to investigate the incidence rates and risk factors of acute kidneyinjury associated with colistimethate by using the standardized definition in critically ill patients. Methods: This studyretrospectively reviewed the electronic medical records of 71 adult patients above 18 years old receiving intravenouscolistimethate at least 48 hours at intensive care unit, university-affiliated hospital from Nov 2012 to Aug 2013 andexcluded patients with end-stage renal disease (ESRD) and required renal replacement therapy before initiation of thecolistimethate therapy. Acute kidney injury (AKI) was determined by using the standardized RIFLE criteria, classifiedwith risk, injury, failure, loss and ESRD according to serum creatinine (Scr) levels. Results: Among the 71 patientsincluded in the analysis, AKI developed in 40 patients (56.3%) and 6 patients (8.4%) had irreversible kidney injury. AKIoccurred within 5 days in 20 patients (50.0%). Maximum Scr level showed a significant increase in the patients with AKI(1.92±0.86 mg/dL vs. 1.12±0.46 mg/dL p=0.001), maximum BUN also increased (64.2±28.7 mg/dL vs. 48.4±24.9 mg/dLp=0.017) and minimum creatinine clearance (CLcr) was significantly decreased in the patients with AKI than non-AKI(34.5±18.6 ml/min vs. 64.4±33.7 ml/min p=0.185). The patients with AKI had significantly longer duration of colistimethatetherapy (21.1±17.0 days vs. 13.0±11.5 days, p=0.020) and larger cumulative doses of colistimethate (6465.9±4717.0 mg vs. 4438.1±3426.7 mg, p=0.040). Conclusion: The incidence and severity of AKI associated with colistimethatein critically ill patients was high and serious. Drug monitoring program should be performed to shorten durationof therapy and reduce cumulative dose from initiation of colistimethate therapy for minimizing AKI of colistimethate.
Abstract
Objective: Colistimethate was first became available in 1950s and used until the early 1980s to treat infections causedby gram-negative bacteria and was abandoned due to its nephrotoxicity and neurotoxicity. However, it was recently reintroducedinto the clinical practices due to emergence of multidrug-resistance gram-negative bacteria, particularlyPseudomonas aeruginosa and Acinetobacter baumanii. Therefore, it is increasingly used in the intensive care unit settingsas a salvage therapy. This study was designed to investigate the incidence rates and risk factors of acute kidneyinjury associated with colistimethate by using the standardized definition in critically ill patients. Methods: This studyretrospectively reviewed the electronic medical records of 71 adult patients above 18 years old receiving intravenouscolistimethate at least 48 hours at intensive care unit, university-affiliated hospital from Nov 2012 to Aug 2013 andexcluded patients with end-stage renal disease (ESRD) and required renal replacement therapy before initiation of thecolistimethate therapy. Acute kidney injury (AKI) was determined by using the standardized RIFLE criteria, classifiedwith risk, injury, failure, loss and ESRD according to serum creatinine (Scr) levels. Results: Among the 71 patientsincluded in the analysis, AKI developed in 40 patients (56.3%) and 6 patients (8.4%) had irreversible kidney injury. AKIoccurred within 5 days in 20 patients (50.0%). Maximum Scr level showed a significant increase in the patients with AKI(1.92±0.86 mg/dL vs. 1.12±0.46 mg/dL p=0.001), maximum BUN also increased (64.2±28.7 mg/dL vs. 48.4±24.9 mg/dLp=0.017) and minimum creatinine clearance (CLcr) was significantly decreased in the patients with AKI than non-AKI(34.5±18.6 ml/min vs. 64.4±33.7 ml/min p=0.185). The patients with AKI had significantly longer duration of colistimethatetherapy (21.1±17.0 days vs. 13.0±11.5 days, p=0.020) and larger cumulative doses of colistimethate (6465.9±4717.0 mg vs. 4438.1±3426.7 mg, p=0.040). Conclusion: The incidence and severity of AKI associated with colistimethatein critically ill patients was high and serious. Drug monitoring program should be performed to shorten durationof therapy and reduce cumulative dose from initiation of colistimethate therapy for minimizing AKI of colistimethate.
참고문헌 (37)
- Hartzell JD, "Nephrotoxicity associated with intravenous colistin (colistimethate sodium) treatment at a tertiary care medical center", Clin Infect Dis, 48(12), pp.1724~1728 (2009)
- Schindler M, "Interaction of divalent cations and polymyxin B with lipopolysaccharide", Biochemistry, 18(20), pp.4425~4430 (1979)
- Brown JM, "Acute renal failure due to overdosage of colistin", Med J Aust, 2(20), pp.923~924 (1970)
- Falagas ME, "Toxicity of polymyxins: a systematic review of the evidence from old and recent studies", Critical care, 10(1), pp.R27~ (2006)
- "Micromedex2.0. Colistimethate sodium"[URL]
- Koch-Weser J, "Adverse effects of sodium colistimethate. Manifestations and specific reaction rates during 317 courses of therapy", Ann Intern Med, 72(6), pp.857~868 (1970)
- Goverman J, "Intravenous colistin for the treatment of multi-drug resistant, gramnegative infection in the pediatric burn population", J Burn Care Res, 28(3), pp.421~426 (2007)
- Kallel H, "Safety and efficacy of colistin compared with imipenem in the treatment of ventilator-associated pneumonia: a matched case-control study", Intensive care med, 33(7), pp.1162~1167 (2007)
- Levin AS, "Intravenous colistin as therapy for nosocomial infections caused by multidrugresistant Pseudomonas aeruginosa and Acinetobacter baumannii", Clin Infect Dis, 28(5), pp.1008~1011 (1999)
- Linden PK, "Use of parenteral colistin for the treatment of serious infection due to antimicrobial-resistant Pseudomonas aeruginosa", Clin Infect Dis, 37(11), pp.e154~e160 (2003)
- Berg JR, "Modulation of polymyxin B effects on mammalian urinary bladder", Am J Physiol, 275(2Pt2), pp.F204~F215 (1998)
- Gaynes R, "Overview of nosocomial infections caused by gram-negative bacilli", Clin Infect Dis, 41(6), pp.848~854 (2005)
- Gales AC, "Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY Antimicrobial Surveillance Program (2006-09)", J Antimicrob Chemother, 66(9), pp.2070~2074 (2011)
- Falagas ME, "Colistin: the revival of polymyxins for the management of multidrug-resistant gram-negative bacterial infections", Clin Infect Dis, 40(9), pp.1333~1341 (2005)
- Markou N, "Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients", Critical care, 7(5), pp.R78~R83 (2003)
- Kallel H, "Colistin as a salvage therapy for nosocomial infections caused by multidrug-resistant bacteria in the ICU", Int J Antimicrob Agents, 28(4), pp.366~369 (2006)
- Li J, "Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria", Int J Antimicrob Agents, 25(1), pp.11~25 (2005)
- Livermore DM, "The need for new antibiotics", Clin Microbiol Infect, 10(Suppl 4), pp.1~9 (2004)
- Falagas ME, "Nephrotoxicity of intravenous colistin: a prospective evaluation", Int J Antimicrob Agents, 26(6), pp.504~507 (2005)
- Falagas ME, "Effectiveness and nephrotoxicity of intravenous colistin for treatment of patients with infections due to polymyxin-onlysusceptible (POS) gram-negative bacteria", Eur J Clin Microbiol Infect Dis, 25(9), pp.596~599 (2006)
- Kasiakou SK, "Combination therapy with intravenous colistin for management of infections due to multidrug-resistant Gramnegative bacteria in patients without cystic fibrosis", Antimicrob Agents Chemother, 49(8), pp.3136~3146 (2005)
- Landman D, "Polymyxins revisited", Clin Microbiol Rev, 21(3), pp.449~465 (2008)
- Spapen H, "Renal and neurological side effects of colistin in critically ill patients", Ann Intensive Care, 1(1), pp.14~ (2011)
- Doshi NM, "Nephrotoxicity associated with intravenous colistin in critically ill patients", Pharmacotherapy, 31(12), pp.1257~1264 (2011)
- Kim J, "Clinical characteristics and risk factors of colistin-induced nephrotoxicity", Int J Antimicrob Agents, 34(5), pp.434~438 (2009)
- Kwon JA, "Predictors of acute kidney injury associated with intravenous colistin treatment", Int J Antimicrob Agents, 35(5), pp.473~477 (2010)
- Kellum JA, "Definition and classification of acute kidney injury", Nephron Clin Pract, 109(4), pp.c182~c187 (2008)
- Deryke CA, "Colistin dosing and nephrotoxicity in a large community teaching hospital", Antimicrob Agents Chemother, 54(10), pp.4503~4505 (2010)
- Montero M, "Effectiveness and safety of colistin for the treatment of multidrug-resistant Pseudomonas aeruginosa infections", Infection, 37(5), pp.461~465 (2009)
- Akajagbor DS, "Higher Incidence of Acute Kidney Injury With Intravenous Colistimethate Sodium Compared With Polymyxin B in Critically Ill Patients at a Tertiary Care Medical Center", Clin Infect Dis, 57(9), pp.1300~1303 (2013)
- Reina R, "Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort study", Intensive care med, 31(8), pp.1058~1065 (2005)
- Michalopoulos AS, "Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic", Clin Microbiol Infect, 11(2), pp.115~121 (2005)
- 남우진, "Colistin 투여 중 발생한 급성 신손상의 임상적 의의", Kidney Research and Clinical Practice, 30(5), pp.484~491 (2011), 대한신장학회
- Imberti R, "Steady-state pharmacokinetics and BAL concentration of colistin in critically Ill patients after IV colistin methanesulfonate administration", Chest, 138(6), pp.1333~1339 (2010)
- Rattanaumpawan P, "Risk factors for colistin-associated nephrotoxicity", J Infect, 62(2), pp.187~190 (2011)
- Ko H, "Early acute kidney injury is a risk factor that predicts mortality in patients treated with colistin", Nephron Clin Pract, 117(3), pp.c284~c288 (2011)
- "Kidney function tests"[URL]