Incidencia de nefrotoxicitad por colistina en una institución de cuarto nivel de Bogotá

Abstract

Introduction: Colistin has been brought back to current clinical practice as a “last resource” antibiotic for treating infections caused by multidrug-resistant gram-negative bacteria. However, its widely known renal toxicity still implies risks for patient safety. Objective: To determine the incidence of nephrotoxicity associated with intravenous colistin use in adults. Methods: Observational analytic historic cohort study. Adult patients treated between January, 2017 and December, 2018 in a fourth level hospital in Bogotá were included. Outcome was defined as acute kidney injury according to AKIN criteria. Results: 65 courses administered to 57 patients between 19 and 94 years and average weight of 65,6 kg (SD: 15,9) were analyzed. Colistin was indicated for treating infections mainly caused by Klebsiella pneumoniae (38,5%) and Pseudomonas aeruginosa (30,8%). Median treatment length was 10 days and sterile cultures were achieved in 87,1% of the cases (n=32). 21 patients in the cohort developed nephrotoxicity (40,4%, n=52). Weight (p=0,010; CI95% 2,9–20,3) and basal serum creatinine levels (p=0,008) are risk factors for nephrotoxicity. Discussion: Although said results are consistent with previous studies, comparability is limited given population heterogeneity, differences with regards to drug dosing and prescription and the diverse definitions for acute kidney injury adopted throughout time. Clinical and paraclinical follow-up is required in order to ensure patient safety while treated with colistin.