{"title":"Acute kidney injury with intravenous colistin sulfate compared with polymyxin B in critically ill patients: A real-world, retrospective cohort study.","authors":"Qin-Jie Yang, Bi-Xiao Xiang, Mong-Hsiu Song, Chien-Yi Yang, Jun-Hao Liang, Yue-Liang Xie, Xiao-Cong Zuo","doi":"10.1002/phar.4601","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Polymyxins have re-emerged as a last-resort therapeutic option for infections caused by carbapenem-resistant gram-negative bacteria. Nephrotoxicity induced by polymyxins is a significant limitation of its use in the clinic. Polymyxin B and colistin sulfate are two widely used active formulations of polymyxins. However, there is a lack of studies conducting a comparative assessment of nephrotoxicity between the two formulations. This study aimed to compare the nephrotoxicity of polymyxin B and colistin sulfate in critically ill patients.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study among critically ill patients who received intravenous polymyxin B or colistin sulfate for over 48 h from January 2017 to January 2024. The primary outcome was the incidence of acute kidney injury (AKI) associated with polymyxins, and the secondary outcome was 30-day all-cause mortality. Additionally, the risk factors of polymyxins-induced AKI and 30-day all-cause mortality were identified by Cox proportional hazard regression analysis.</p><p><strong>Results: </strong>A total of 473 patients were included in this study. The overall incidence of AKI was significantly higher in patients who received polymyxin B compared to those who received colistin sulfate in the unmatched cohort (20.8% vs. 9.0%, p = 0.002) and in the propensity score matching cohort (21.1% vs. 7.0%, p = 0.004), respectively. However, there was no significant difference in 30-day all-cause mortality between the two groups. Polymyxin type, septic shock, and concomitant use of vasopressors were identified as independent risk factors for polymyxin-induced AKI.</p><p><strong>Conclusions: </strong>The prevalence of AKI was higher among patients who received polymyxin B compared to those treated with colistin sulfate. However, there was no significant difference in 30-day all-cause mortality between the two groups. Further prospective, multicenter studies with larger sample sizes are needed to validate these findings.</p>","PeriodicalId":20013,"journal":{"name":"Pharmacotherapy","volume":" ","pages":"631-641"},"PeriodicalIF":2.9000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pharmacotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/phar.4601","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/24 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Polymyxins have re-emerged as a last-resort therapeutic option for infections caused by carbapenem-resistant gram-negative bacteria. Nephrotoxicity induced by polymyxins is a significant limitation of its use in the clinic. Polymyxin B and colistin sulfate are two widely used active formulations of polymyxins. However, there is a lack of studies conducting a comparative assessment of nephrotoxicity between the two formulations. This study aimed to compare the nephrotoxicity of polymyxin B and colistin sulfate in critically ill patients.
Methods: We conducted a retrospective cohort study among critically ill patients who received intravenous polymyxin B or colistin sulfate for over 48 h from January 2017 to January 2024. The primary outcome was the incidence of acute kidney injury (AKI) associated with polymyxins, and the secondary outcome was 30-day all-cause mortality. Additionally, the risk factors of polymyxins-induced AKI and 30-day all-cause mortality were identified by Cox proportional hazard regression analysis.
Results: A total of 473 patients were included in this study. The overall incidence of AKI was significantly higher in patients who received polymyxin B compared to those who received colistin sulfate in the unmatched cohort (20.8% vs. 9.0%, p = 0.002) and in the propensity score matching cohort (21.1% vs. 7.0%, p = 0.004), respectively. However, there was no significant difference in 30-day all-cause mortality between the two groups. Polymyxin type, septic shock, and concomitant use of vasopressors were identified as independent risk factors for polymyxin-induced AKI.
Conclusions: The prevalence of AKI was higher among patients who received polymyxin B compared to those treated with colistin sulfate. However, there was no significant difference in 30-day all-cause mortality between the two groups. Further prospective, multicenter studies with larger sample sizes are needed to validate these findings.
背景：多粘菌素已重新成为耐碳青霉烯革兰阴性菌感染的最后治疗选择。多粘菌素引起的肾毒性是其临床应用的一大限制。多粘菌素 B 和硫酸可乐定是两种广泛使用的多粘菌素活性制剂。然而，目前缺乏对这两种制剂的肾毒性进行比较评估的研究。本研究旨在比较多粘菌素 B 和硫酸秋水仙碱对重症患者的肾毒性：我们对 2017 年 1 月至 2024 年 1 月期间静脉注射多粘菌素 B 或硫酸秋水仙碱超过 48 小时的重症患者进行了一项回顾性队列研究。主要结果是与多粘菌素相关的急性肾损伤（AKI）发生率，次要结果是30天全因死亡率。此外，还通过 Cox 比例危险回归分析确定了多粘菌素诱发急性肾损伤和 30 天全因死亡率的风险因素：结果：本研究共纳入了 473 名患者。在未匹配队列（20.8% vs. 9.0%，p = 0.002）和倾向评分匹配队列（21.1% vs. 7.0%，p = 0.004）中，接受多粘菌素 B 的患者的 AKI 总发生率明显高于接受硫酸可乐定的患者。不过，两组患者的 30 天全因死亡率没有明显差异。结论：多粘菌素类型、脓毒性休克和同时使用血管加压药是多粘菌素诱发AKI的独立风险因素：结论：与接受硫酸秋水仙碱治疗的患者相比，接受多粘菌素 B 治疗的患者发生 AKI 的比例更高。然而，两组患者的 30 天全因死亡率并无明显差异。需要进一步开展样本量更大的前瞻性多中心研究来验证这些发现。
期刊介绍：
Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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