Sorlí Luisa, Luque Sonia, Grau Santiago, Berenguer Núria, Segura Concepción, Montero María Milagro, Alvarez-Lerma Francisco, Knobel Hernando, Benito Natividad, Horcajada Juan P
Infectious Diseases Service, Parc de Salut Mar, Passeig Marítim 25-29, E-08003 Barcelona, Spain.
BMC Infect Dis. 2013 Aug 19;13:380. doi: 10.1186/1471-2334-13-380.
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.
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 (Cmin) and 30 minutes after CMS infusion (Cmax). 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.
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, Cmin (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), Cmin (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 Cmin 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.
When using the RIFLE criteria, colistin-related nephrotoxicity is observed in a high percentage of patients. Cmin levels are predictive of AKI. Patients who receive intravenous colistin should be closely monitored and Cmin might be a new useful tool to predict AKI.
关于多黏菌素使用的最有效和毒性最小方案的数据很少。本研究的目的是确定多黏菌素相关肾毒性的发生率及潜在危险因素，包括多黏菌素血浆水平。
对接受静脉注射甲磺酸多黏菌素钠（CMS）的患者进行了为期一年多的前瞻性观察队列研究。在CMS输注前即刻（Cmin）和输注后30分钟（Cmax）采集血样检测多黏菌素血浆水平。在基线、第7天和治疗结束时（EOT）评估肾功能。急性肾损伤（AKI）的严重程度根据RIFLE（风险、损伤、衰竭、丧失和终末期肾病）标准定义。
102例患者符合纳入标准。分别在第7天和治疗结束时（EOT）观察到26例（25.5%）和50例（49.0%）患者发生与CMS治疗相关的AKI。在第7天，Cmin（比值比，4.63[2.33 - 9.20]；P < 0.001）是AKI的唯一独立预测因素。在EOT时，Charlson评分（比值比1.26[1.01 - 1.57]；P = 0.036）、Cmin（比值比2.14[1.33 - 3.42]；P = 0.002）以及同时使用≥2种肾毒性药物（比值比2.61[1.0 - 6.8]；P = 0.049）是AKI的独立危险因素。当将Cmin作为分类变量评估时，在第7天更好预测AKI的切点为3.33 mg/L（P < 0.001），在EOT时为2.42 mg/L（P < 0.001）。
使用RIFLE标准时，观察到高比例患者发生多黏菌素相关肾毒性。Cmin水平可预测AKI。接受静脉注射多黏菌素的患者应密切监测，Cmin可能是预测AKI的一种新的有用工具。
