Sangthawan Pornpen, Geater Alan Frederick, Naorungroj Surarit, Nikomrat Piyarat, Nwabor Ozioma Forstinus, Chusri Sarunyou
Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
Antibiotics (Basel). 2021 Dec 21;11(1):2. doi: 10.3390/antibiotics11010002.
Multidrug-resistant Gram-negative infection is a major global public health threat. Currently, colistin is considered the last-resort treatment despite its nephrotoxicity. The purpose of this study was to estimate the incidence, characteristics, and influencing factors and to develop a prediction model for colistin-associated nephrotoxicity. A retrospective study was conducted in the university hospital in the South of Thailand from December 2015 to June 2019. A total of 381 patients (median age (IQR) of 64 (51-62) years) were analyzed. Overall, 282 (74%) had nephrotoxicity according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification. In-hospital, 30-day mortality rates and cost of hospital admission were significantly higher among those with nephrotoxicity. Age > 60 years, comorbidities, serum albumin less than 3.5 g/dL, and concomitant nephrotoxic use were significantly associated with colistin-associated nephrotoxicity with adjusted OR (95% CI) 2.01 (1.23-2.45), 1.85 (1.18-3.6), 1.68 (1.09-2.99), and 1.77 (1.10-2.97), respectively. The prediction model for high-risk colistin-associated nephrotoxicity was identified with good overall performance (specificity of 79.6% (95% CI 70.3-87.1) and positive predictive value of 92.1% (95% CI 88.0-95.1)). In conclusion, the incidence of colistin-associated nephrotoxicity was high and incurred significant morbidity, mortality, and economic burden. Our predictive scoring system is relatively simple and useful for optimizing colistin therapy.
多重耐药革兰氏阴性菌感染是全球主要的公共卫生威胁。目前，尽管有肾毒性，黏菌素仍被视为最后的治疗手段。本研究的目的是估计黏菌素相关肾毒性的发生率、特征和影响因素，并建立一个预测模型。2015年12月至2019年6月在泰国南部的大学医院进行了一项回顾性研究。共分析了381例患者（中位年龄（四分位间距）为64（51 - 62）岁）。总体而言，根据改善全球肾脏病预后组织（KDIGO）分类，282例（74%）出现肾毒性。在医院中，肾毒性患者的30天死亡率和住院费用显著更高。年龄>60岁、合并症、血清白蛋白低于3.5 g/dL以及同时使用肾毒性药物与黏菌素相关肾毒性显著相关，校正后的比值比（95%置信区间）分别为2.01（1.23 - 2.45）、1.85（1.18 - 3.6）、1.68（1.09 - 2.99）和1.77（1.10 - 2.97）。确定了高风险黏菌素相关肾毒性的预测模型，其总体表现良好（特异性为79.6%（95%置信区间70.3 - 87.1），阳性预测值为92.1%（95%置信区间88.0 - 95.1））。总之，黏菌素相关肾毒性的发生率很高，会导致显著的发病率、死亡率和经济负担。我们的预测评分系统相对简单，有助于优化黏菌素治疗。
