Colistin co-administration with other nephrotoxins: experience of teaching hospital of Latvia
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RESEARCH ARTICLE
Colistin co‑administration with other nephrotoxins: experience of teaching hospital of Latvia Aleksandra Aitullina1,2 · Santa Purviņa1,2 · Angelika Krūmiņa3,4 Received: 20 May 2020 / Accepted: 14 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background Colistin is a potentially nephrotoxic antibiotic used for the management of multidrug-resistant bacterial infections in critically ill patients. Co-administration with other nephrotoxins was reported as a potentially modifiable risk factor of colistin acute kidney injury. Objective To establish the role of colistin dosing and co-medications in development of colistin kidney injury. Setting Community teaching hospital in Latvia. Method Adult patients from intensive care units with diagnosed Gram-negative bacterial infections, undergoing colistin treatment for longer than 72 h, and not receiving renal replacement therapy were included in this retrospective study. Main outcome measure Colistin nephrotoxicity was defined as an increase in the serum creatinine level by at least 50% from the baseline after ≥ 48 h. Results In 73 of 87 cases, Acinetobacter baumannii pneumonia was diagnosed. The nephrotoxicity rate was 27.6% with a median onset of 8 days. In 79% of the cases, colistin was co-administrated with at least one potentially nephrotoxic agent. The most used nephrotoxins were loop diuretics (44 cases), non-steroidal anti-inflammatory drugs (19 cases) and vancomycin (11 cases). The use of nephrotoxins was similar in patients with colistin nephrotoxicity (group-1) and without it (group-2). Carbapenems were more common in group-2 (37% vs 62%, p = 0.004) and a colistin loading dose of 9 MU in group-1 (87% vs 62%, p = 0.027). However, in the multifactor regression analysis, the protective role of carbapenems was not confirmed. Conclusion Potentially nephrotoxic agents are commonly co-administrated with colistin. This study failed to prove their role in the development of acute kidney injury. Keywords Acinetobacter baumannii pneumonia · Acute kidney injury · Co-administration with nephrotoxins · Colistin · Latvia
Impacts on practice • Co-administration of colistin with other nephrotoxins
such as loop diuretics could be justified as they have a clear indication in treating critically ill patients and, possibly, they do not increase the risk of colistin acute injury. • Data about therapeutic drug monitoring of nephrotoxic drugs with a narrow therapeutic index, such as glyco* Aleksandra Aitullina [email protected] 1
Department of Pharmacology, Riga Stradins University, 13 Pilsonu St., Riga 1002, Latvia
2
Paul Stradins Clinical University Hospital, Riga, Latvia
3
Department of Infectology, Riga Stradins University, 3 Linezera St., Riga 1006, Latvia
4
Riga East Clinical University Hospital, Riga, Latvia
peptides or aminoglycosides, is important when these agents are analysed as potential risk factors of colistin nephrotoxicity, because underdosing or overdosing of these agents could potentially influence the
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