Kim Jieun, Lee Kyoung-Ho, Yoo Sunmi, Pai Hyunjoo
Department of Internal Medicine, Hanyang University College of Medicine, 17 Haengdang-dong, Sungdong-gu, Seoul 133-792, South Korea.
Int J Antimicrob Agents. 2009 Nov;34(5):434-8. doi: 10.1016/j.ijantimicag.2009.06.028. Epub 2009 Sep 1.
Since multidrug-resistant gram-negative organisms have been increasing, polymyxin E (colistin) has been reintroduced despite its nephrotoxicity. A case-control study was performed to investigate the incidence, clinical characteristics and risk factors of colistin-induced nephrotoxicity. From August 2006 to June 2008, 47 cases receiving at least one defined daily dose (DDD) of intravenous colistin were included; 15 (31.9%) of the 47 cases developed nephrotoxicity with preserved urine output, 3 (20%) of whom underwent renal replacement therapy. The mean dosage of colistimethate sodium was 2.25 g (22.5 DDD; range 0.6-8.7 g) at the time of nephrotoxicity. Of 10 patients who were re-assessed for renal function after 1 month, 9 (90%) recovered their renal function. In the univariate analysis, site of infection, hypoalbuminaemia and cumulative dosage of the second-generation fluoroquinolones, aminoglycosides and non-steroidal anti-inflammatory drugs (NSAIDs) co-administered during colistin treatment as well as concomitant use of NSAIDs were risk factors for nephrotoxicity. However, in the logistic regression hypoalbuminaemia and the use of NSAIDs were significant risk factors for increased nephrotoxicity during colistin administration, suggesting that free colistin might cause renal toxicity. In conclusion, colistin-induced nephrotoxicity occurred at a high rate, and hypoalbuminaemia and concomitant use of NSAIDs were significant risk factors.
由于耐多药革兰氏阴性菌不断增加，尽管多粘菌素E（黏菌素）具有肾毒性，但仍被重新启用。开展了一项病例对照研究，以调查黏菌素所致肾毒性的发生率、临床特征及危险因素。2006年8月至2008年6月，纳入了47例接受至少一个规定日剂量（DDD）静脉注射黏菌素的患者；47例中有15例（31.9%）出现尿量正常的肾毒性，其中3例（20%）接受了肾脏替代治疗。发生肾毒性时，多粘菌素甲磺酸钠的平均剂量为2.25 g（22.5 DDD；范围0.6 - 8.7 g）。10例患者在1个月后重新评估肾功能，9例（90%）肾功能恢复。单因素分析中，感染部位、低白蛋白血症、黏菌素治疗期间联用的第二代氟喹诺酮类、氨基糖苷类及非甾体抗炎药（NSAIDs）的累积剂量以及NSAIDs的同时使用均为肾毒性的危险因素。然而，在逻辑回归分析中，低白蛋白血症和NSAIDs的使用是黏菌素给药期间肾毒性增加的显著危险因素，提示游离黏菌素可能导致肾毒性。总之，黏菌素所致肾毒性发生率较高，低白蛋白血症和NSAIDs的同时使用是显著危险因素。
