Colistin effectiveness and nephrotoxicity: experience from a tertiary care burns unit in Oman
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ORIGINAL PAPER
Colistin effectiveness and nephrotoxicity: experience from a tertiary care burns unit in Oman Said Al-Busaidi & Adil Mohammed & Vinod Kalarikal Murugan & Sabu Thankappan
Received: 13 November 2012 / Accepted: 12 March 2013 / Published online: 28 March 2013 # Springer-Verlag Berlin Heidelberg 2013
Abstract Background The emergence of multiple drug-resistant (MDR) Gram-negative bacteria and the lack of new antibiotics to combat them have led to the revival of colistin, a drug which was abandoned because of its toxicity. Recent reports showed the drug is effective and relatively safe in burns patients. In this article, we present our experience with the drug. Methods A retrospective study over a period of 2 years was carried out. Forty-eight patients treated with colistin were reviewed and the outcome and nephrotoxicity were assessed. Results The most prevalent MDR organism in our burns unit was Acinetobacter species. MDR Pseudomonas aeruginosa was seen in few cases and it was always associated with Acinetobacter species infection. The maximum cumulative dose was 193,000,000 international units. The maximum duration was 45 days. The mortality was 33.3 %. Renal function test impairment or worsening was seen in 14 patients (29%). There was no statistically significant impairment of renal function. The P value for creatinine was 0.1236. Conclusions Colistin is useful for treating multidrug-resistant organism infections in burns patients when no alternative is
S. Al-Busaidi (*) : A. Mohammed : V. Kalarikal Murugan : S. Thankappan Department of Plastic, Reconstructive and Craniofacial Surgery, Khoula Hospital, PO Box 90, PC 116( Mina’ al Fahal, Muscat, Sultanate of Oman e-mail: [email protected]
available. Renal impairment is a major side effect of this antibiotic and the risk maybe higher in burns patients because the burn itself can cause acute kidney injury. Level of Evidence: Level IV, therapeutic study Keywords Colistin . Burn . Nephrotoxicity . Multidrug resistance . Acinetobacter
Introduction Colistin was discovered in 1949 and was non-ribosomally synthesized by Bacillus polymyxa subspecies colistinus Koyama. Colistin was initially used therapeutically in Japan and in Europe during the 1950s and in the USA in the form of colistimethate sodium in 1959. However, the intravenous formulations of colistin and polymyxin B were gradually abandoned in most parts of the world in the early 1980s because of the reported high incidence of nephrotoxicity [1–3]. The emergence of multiple drug-resistant (MDR) Gramnegative bacteria and the lack of new antibiotics to combat them have led to the revival of polymyxins [2, 3]. Pathogenic bacteria are showing increasing resistance to antimicrobial therapy, and the problem is relatively much worsened recently in Gram-negative bacilli. Acinetobacter baumannii is a typical nosocomial pathogen causing infections and high mortality, almost exclusively in compromised hospital patients [4]. Acute kidney injury (AKI) is a frequent complication in patients with severe bu
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