Alshaya Abdulrahman I, Bin Saleh Khalid, Aldhaeefi Mohammed, Baderldin Hisham A, Alamody Farris O, Alhamdan Qusai A, Almusallam Mohammed A, Alshaya Omar, Al Sulaiman Khalid, Alshareef Shaima, Alowais Shuroug A, Al Harbi Shmeylan A, Alghamdi Ghassan
College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Infect Drug Resist. 2022 Apr 24;15:2159-2166. doi: 10.2147/IDR.S361244. eCollection 2022.
Intravenous (IV) colistin is commonly used to treat multidrug-resistant gram-negative infections. It is primarily eliminated renally and may induce acute kidney injury (AKI) at a rate of up to 53%. Consequently, septic patients who require colistin administration have an additional risk of developing AKI. The aim of this study is to investigate clinical failure and AKI predictors for septic patients treated with IV colistin.
This retrospective cohort study was conducted at a tertiary teaching hospital in Saudi Arabia. Adult septic patients with suspected or confirmed gram-negative infections who received colistin admitted to the hospital between May 2016 and December 2020 were screened after obtaining IRB approval. AKI was defined based on the AKI Network criteria. We investigated the incidence of clinical failure based on colistin dosing and AKI risk factors, such as the development of septic shock, severity of illness, and medication co-administration using a multiple logistic regression model.
After screening 163 patients, 103 patients were included in the analysis. No difference was observed between the colistin dosing strategies for clinical failure. Of the included predictors, development of septic shock (OR: 3.75; 95% CI 1.18-13.15), carbapenem co-administration (OR, 3.96; 95% CI, 1.134-15.57) were associated with an increased risk of AKI. The other factors were not significant predictors.
Clinical failure was not affected by colistin dosing strategies in our cohort of patients with sepsis. Moreover, the co-administration of carbapenems and the development of septic shock may increase the risk of inducing AKI in adult septic patients treated with IV colistin. Further studies are required to confirm these findings.
静脉注射多黏菌素常用于治疗多重耐药革兰氏阴性菌感染。它主要通过肾脏排泄，可能导致高达53%的急性肾损伤（AKI）发生率。因此，需要使用多黏菌素治疗的脓毒症患者发生AKI的风险更高。本研究的目的是调查接受静脉注射多黏菌素治疗的脓毒症患者临床治疗失败和AKI的预测因素。
本回顾性队列研究在沙特阿拉伯的一家三级教学医院进行。在获得机构审查委员会（IRB）批准后，对2016年5月至2020年12月期间入院接受多黏菌素治疗的疑似或确诊革兰氏阴性菌感染的成年脓毒症患者进行筛选。根据急性肾损伤网络（AKI Network）标准定义AKI。我们使用多元逻辑回归模型，根据多黏菌素给药情况和AKI危险因素（如脓毒性休克的发生、疾病严重程度和药物联合使用情况）调查临床治疗失败的发生率。
在筛选了163例患者后，103例患者纳入分析。在临床治疗失败方面，多黏菌素给药策略之间未观察到差异。在所纳入的预测因素中，脓毒性休克的发生（比值比[OR]：3.75；95%置信区间[CI] 1.18 - 13.15）、碳青霉烯类药物联合使用（OR，3.96；95% CI，1.134 - 15.57）与AKI风险增加相关。其他因素不是显著的预测因素。
在我们的脓毒症患者队列中，临床治疗失败不受多黏菌素给药策略的影响。此外，碳青霉烯类药物的联合使用和脓毒性休克的发生可能会增加接受静脉注射多黏菌素治疗的成年脓毒症患者发生AKI的风险。需要进一步研究来证实这些发现。
