Professional paper
THE IMPACT OF COLISTIN ON RENAL FUNCTION IN CRITICAL PATIENTS
IVA GRGIĆ
; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
DUBRAVKA IVIĆ
; Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek University Hospital Centre, Department of Intensive Care, Osijek, Croatia
DINKO PAULIĆ
orcid.org/0000-0001-9890-2755
; Institute of Public Health of Osijek-Baranja County, Microbiology Department, Osijek, Croatia
Abstract
Objective: The aim of this research was to assess the infl uence of colistin on renal function in critical patients, the frequency and severity of renal dysfunction, factors that, along with colistin, contribute to the onset of acute kidney injury (AKI), and the effects of AKI on clinical outcome. Study design: Observational retrospective study. Participants and Methods: The study included 58 patients hospitalized at the Intensive Care Unit of the Department of Anesthesiology and Intensive Care over a two-year period. The inclusion criterion was targeted therapeutic use of colistin. Demographic and clinical data on patients were collected from their medical records. Results: Colistin was used for targeted treatment of microbiologically confi rmed infections. In more than 70% of patients, it was administered systematically, and in 80% of cases in combination with other antibiotics. Five patients received a loading dose of colistin, the median maintenance dose was 6 million IU, the cumulative dose was 41 million IU, and median duration of treatment was 7 days. AKI was established in 12 subjects between the 2nd and 14th day of therapy, with a uniform representation of injuries of the 1st, 2nd and 3rd degree. The duration of therapy, doses of colistin and sepsis were not proven to significantly affect the incidence of AKI. The mortality rate in AKI patients was 75%. Conclusion: In most subjects, colistin was administered systematically in combination with other antibiotics, and in few cases inhaled as the only antimicrobial agent. Although apparent, the increase of creatinine concentration, reduction of clearance and glomerular filtration during the administration of colistin did not reach statistical significance. In the subjects with known AKI, colistin did not induce further aggravation of renal function. AKI resulting from the use of colistin is probably a consequence of the combined effect of several factors, one of which is latent renal dysfunction as part of the critical illness.
Keywords
acute kidney injury; critical illness; colistin; adverse effects; nephrotoxicity
Hrčak ID:
224704
URI
Publication date:
6.9.2019.
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