Rashizal Sazli M R, Syed Mohamed A F, Wan Mazuan W M, Ling S M, Mahmud A, Amin Nordin S
Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, 43400 Serdang, Selangor, Malaysia.
Herbal Medicine Research Centre, Institute for Medical Research, Kuala Lumpur, Malaysia.
Med J Malaysia. 2017 Apr;72(2):100-105.
The increasing trend of extensively drugresistant gram negative bacteria responsible for nosocomial infections has prompted resurgence colistin usage. Colistin-induced nephrotoxicity is a concern with disparity in the reported rates between previous studies. This study aims to evaluate colistin-induced nephrotoxicity among Malaysian population.
The medical records of ICU patients receiving colistin therapy in Hospital Serdang and Hospital Sungai Buloh from 2010 to 2012 were retrospectively reviewed. Demographics data, treatment characteristic as well as culture result and creatinine level were documented. Nephrotoxicity was determined based on RIFLE criteria.
A total of 100 patients were included. Median daily dose, cumulative dose and duration of colistin therapy were 3.0 MIU (IQR: 4, range 1-12), 17.8 MIU (IQR: 31.5, range 2-180) and seven days (IQR: 4, range 1-30). Nephrotoxicity was found in 23% of the study population. All cases were reversible but marginally associated with higher mortality. No statistical association exist between age, gender and race as well as administration routes with nephrotoxicity by univariable analysis. The association of dose and duration with nephrotoxicity was also not significant by univariable analysis. After adjustment for confounders, statistical association between the independent variables and dependent variable remains not significant.
Lower dose and shorter duration in local settings contribute to lack of association between colistin therapy and nephrotoxicity in this study. Higher dosing regimen with loading dose application has been introduced in the latest National Antibiotic Guideline. Further evaluation of colistin-induced nephrotoxicity and potential risk factors is therefore warranted.
导致医院感染的广泛耐药革兰氏阴性菌呈上升趋势，促使多黏菌素的使用再度兴起。多黏菌素引起的肾毒性令人担忧，此前研究报道的发生率存在差异。本研究旨在评估马来西亚人群中多黏菌素引起的肾毒性。
回顾性分析了2010年至2012年在斯里淡医院和双溪毛糯医院接受多黏菌素治疗的ICU患者的病历。记录了人口统计学数据、治疗特征以及培养结果和肌酐水平。根据RIFLE标准确定肾毒性。
共纳入100例患者。多黏菌素治疗的中位日剂量、累积剂量和持续时间分别为3.0 MIU（四分位间距：4，范围1 - 12）、17.8 MIU（四分位间距：31.5，范围2 - 180）和7天（四分位间距：4，范围1 - 30）。23%的研究人群出现肾毒性。所有病例均可逆转，但与较高死亡率略有相关。单因素分析显示，年龄、性别、种族以及给药途径与肾毒性之间无统计学关联。剂量和持续时间与肾毒性之间的关联在单因素分析中也不显著。在对混杂因素进行调整后，自变量与因变量之间的统计学关联仍然不显著。
在本研究中，当地较低的剂量和较短的疗程导致多黏菌素治疗与肾毒性之间缺乏关联。最新的国家抗生素指南引入了更高剂量的负荷剂量给药方案。因此，有必要进一步评估多黏菌素引起的肾毒性及潜在危险因素。
