Colistimethate 투여량 적절성 평가 및 급성 신손상 발현 양상 분석
Evaluation of the Appropriate Use of Colistimethate and Development of Acute Kidney Injury
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Colistimethate was first introduced in the 1950s and was used until the early 1980s to treat infections caused by gram-negative rods. It was abandoned due to nephrotoxicity and the introduction of safer alternatives. However, the increase in multidrug-resistant (MDR) bacterial infections has resulted in a significant increase in the use of colistimethate. This retrospective study was designed to evaluate the appropriate use of colistimethate and development of AKI (acute kidney injury). From April 2010 to April 2011, 78 adult patients receiving colistimethate ≥ 2 days were enrolled. The dose appropriateness evaluation was based on previous studies and according to renal impairment. AKI was defined using risk, injury, failure, loss and end-stage kidney injury (RIFLE) criteria, according to the serum creatinine levels. At initial dosing, only 38 patients (49%) received the appropriate dose, 27 patients (34%) received an excessive dose, and 13 patients (17%) received a low dose. Following initial dosing, renal function exacerbation occurred in 44 patients (56%), among the 44 patients, 31 patients (70%) received reduced dose, and only 9 patients (29%) received the appropriate dose. AKI developed in 49 patients. Independent predictors for nephrotoxicity were age (OR=1.107, 95% CI 1.016~1.127, p=0.010) and baseline serum creatinine levels (OR=0.107, 95% CI 0.018~0.645, p=0.015). In conclusion, the appropriate colistimethate dose should be administered based on weight and renal function and if nephrotoxicity develops, the dose should be reduced to the appropriate levels. According to age and baseline serum creatinine levels, we can predict AKI. We expect this study will be a foundation to identify the optimal colistimethate dose from both efficacy and toxicity perspectives and establish CSS (computerized survillance system) at the Samsung Medical Center.
Abstract
Colistimethate was first introduced in the 1950s and was used until the early 1980s to treat infections caused by gram-negative rods. It was abandoned due to nephrotoxicity and the introduction of safer alternatives. However, the increase in multidrug-resistant (MDR) bacterial infections has resulted in a significant increase in the use of colistimethate. This retrospective study was designed to evaluate the appropriate use of colistimethate and development of AKI (acute kidney injury). From April 2010 to April 2011, 78 adult patients receiving colistimethate ≥ 2 days were enrolled. The dose appropriateness evaluation was based on previous studies and according to renal impairment. AKI was defined using risk, injury, failure, loss and end-stage kidney injury (RIFLE) criteria, according to the serum creatinine levels. At initial dosing, only 38 patients (49%) received the appropriate dose, 27 patients (34%) received an excessive dose, and 13 patients (17%) received a low dose. Following initial dosing, renal function exacerbation occurred in 44 patients (56%), among the 44 patients, 31 patients (70%) received reduced dose, and only 9 patients (29%) received the appropriate dose. AKI developed in 49 patients. Independent predictors for nephrotoxicity were age (OR=1.107, 95% CI 1.016~1.127, p=0.010) and baseline serum creatinine levels (OR=0.107, 95% CI 0.018~0.645, p=0.015). In conclusion, the appropriate colistimethate dose should be administered based on weight and renal function and if nephrotoxicity develops, the dose should be reduced to the appropriate levels. According to age and baseline serum creatinine levels, we can predict AKI. We expect this study will be a foundation to identify the optimal colistimethate dose from both efficacy and toxicity perspectives and establish CSS (computerized survillance system) at the Samsung Medical Center.
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