Koksal Iftihar, Kaya Selcuk, Gencalioglu Eda, Yilmaz Gurdal
Infectious Diseases and Clinical Microbiology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey.
Oman Med J. 2016 Jul;31(4):318-21. doi: 10.5001/omj.2016.62.
We investigated the incidence of and risk factors for nephrotoxicity in patients using intravenous colistin.
This retrospective, observational study was conducted at Karadeniz Technical University, Faculty of Medicine, clinics and intensive care unit between 1 January 2009 and 1 January 2013. Intravenous colistin was administered to 133 patients at a dose of 2.5-5.0 mg/kg/day.
The patients mean age was 54.3±19.1 years and the mean duration of treatment was 13.5±3.6 days. Nephrotoxicity developed in 5.0±2.8 days in 38 (28.6%) patients. Based on RIFLE (risk, injury, failure, loss of kidney function, and end-stage kidney disease) criteria, 15 (39.5%) patients were class 1, 17 (44.7%) were class 2, six (15.8%) were class 3, and none were class 4. The mean duration of development of nephrotoxicity was 5.0±2.8 days. Hemodialysis requirement was observed in two (5.2%) of the 38 patients who developed nephrotoxicity. In these cases, colistin therapy was not discontinued. Nephrotoxicity was correlated with advanced age, high pretreatment serum creatinine levels, diabetes mellitus, and chronic obstructive pulmonary disease.
The use of colistin is relatively safe for patients that have normal renal functions. However, better standardization of the definition of nephrotoxicity in those patients with the use of scoring systems and close monitoring are necessary.
我们调查了使用静脉注射多黏菌素的患者中肾毒性的发生率及危险因素。
这项回顾性观察性研究于2009年1月1日至2013年1月1日在黑海技术大学医学院的诊所和重症监护病房进行。133例患者接受静脉注射多黏菌素治疗，剂量为2.5 - 5.0mg/kg/天。
患者的平均年龄为54.3±19.1岁，平均治疗时长为13.5±3.6天。38例（28.6%）患者在5.0±2.8天出现肾毒性。根据RIFLE（风险、损伤、衰竭、肾功能丧失和终末期肾病）标准，15例（39.5%）患者为1级，17例（44.7%）为2级，6例（15.8%）为3级，无4级患者。肾毒性发生的平均时长为5.0±2.8天。在发生肾毒性的38例患者中，有2例（5.2%）需要进行血液透析。在这些病例中，多黏菌素治疗未中断。肾毒性与高龄、治疗前血清肌酐水平高、糖尿病和慢性阻塞性肺疾病相关。
对于肾功能正常的患者，使用多黏菌素相对安全。然而，对于这些患者，有必要更好地通过评分系统对肾毒性定义进行标准化，并进行密切监测。
