Yu Shi Nae, Kim Tark, Park Se Yoon, Lee Yu-Mi, Park Ki-Ho, Lee Eun Jung, Jeon Min Hyok, Choo Eun Ju, Kim Tae Hyong, Lee Mi Suk, Park Seong Yeon
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea.
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
Microb Drug Resist. 2021 Aug;27(8):1029-1036. doi: 10.1089/mdr.2020.0312. Epub 2021 Mar 3.
Colistin is an, antibiotic used to treat carbapenem-resistant complex (CRABC) infection. However, colistin is well known for its nephrotoxicity. To accurately assess the effects of colistin on acute kidney injury (AKI) and 28-day mortality, we investigated the risk factors associated with AKI and mortality in patients with CRABC bacteremia who received or never received colistin. Patients with CRABC bacteremia aged ≥18 years were retrospectively identified for 3 years at five tertiary teaching hospitals. AKI was defined by using the Kidney Disease Improving Global Outcomes criteria. AKI developed in 103 (34.9%) of the 295 patients enrolled patients. AKI developed more frequently in patients who received colistin than in patients who did not (46.7% vs. 29.5%, = 0.004). Multivariate analysis showed that intravenous colistin usage was an independent risk factor for AKI in these patients. Nonfatal disease, catheter-related bloodstream infection, and administration of colistin were protective factors for 28-day mortality. However, the sequential organ failure assessment score and AKI were associated with poor outcomes. In conclusion, colistin may be a double-edged sword; although it causes AKI, it also reduces 28-day mortality in patients with CRABC bacteremia. Therefore, colistin administration as an appropriate antibiotic may improve CRABC bacteremia prognosis, despite its nephrotoxicity.
黏菌素是一种用于治疗耐碳青霉烯类肠杆菌科细菌（CRABC）感染的抗生素。然而，黏菌素因其肾毒性而广为人知。为了准确评估黏菌素对急性肾损伤（AKI）和28天死亡率的影响，我们调查了接受或从未接受黏菌素治疗的CRABC菌血症患者中与AKI和死亡率相关的危险因素。在五家三级教学医院对年龄≥18岁的CRABC菌血症患者进行了为期3年的回顾性研究。AKI采用改善全球肾脏病预后组织（KDIGO）标准进行定义。在纳入研究的295例患者中，103例（34.9%）发生了AKI。接受黏菌素治疗的患者发生AKI的频率高于未接受黏菌素治疗的患者（46.7%对29.5%，P = 0.004）。多因素分析显示，静脉使用黏菌素是这些患者发生AKI的独立危险因素。非致命性疾病、导管相关血流感染和黏菌素的使用是28天死亡率的保护因素。然而，序贯器官衰竭评估（SOFA）评分和AKI与不良预后相关。总之，黏菌素可能是一把双刃剑；尽管它会导致AKI，但它也能降低CRABC菌血症患者的28天死亡率。因此，尽管黏菌素有肾毒性，但作为一种合适的抗生素使用可能会改善CRABC菌血症的预后。
