762. Predictors Of Colistin Nephrotoxicity : A Multicenter Study 
Session: Poster Abstract Session: Antimicrobials: Treatment of HAI and Resistant Infections
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • poster idsa jpeg.jpg (1022.5 kB)
  • Background: To determine the outcomes of colistin (COL) use and to establish the risk factors contributing to COL related nephrotoxicity (NTX).

    Methods: A multicenter retrospective nested case-control study of adult patients receiving intravenous COL for at least 72 hours was performed at 9 separate referral hospitals between January 2010 and October 2012. Patients were divided into three groups:

    • 1) Those with a baseline SCR ≤1,5 mg/dLand no increase in SCR during COL treatment or a small rise lower than 1,5 fold
    • 2) Those with a baseline SCR ≤1,5 mg/dL and at least 1,5 fold increase during or within the following 7 days of discontinuation of COL treatment
    • 3) Those with acute or chronic renal failure defined on the basis of GFR or with a baseline SCR >1,5 mg/dL.

    NTX was graded according to RIFLE criteria. Categorical variables were compared with chi-square and continuous variables with Student's t-test. Spearman correlation test was performed to determine the parameters related with NTX.

    Results: A total of 198 pts were included in the study, 121 (61,1%) were male and mean age was 58,7 (±18,9). The majority of the patients were hospitalized in intensive care units (69,7%) and 75,4% had at least one comorbidity. NTX was occured in 77(46,1%) of the patients with normal initial SCR levels and was graded as Risk (SCRX1,5) in 22%, Injury(SCRX2) in 32,5% and Failure (SCRX3) in 45,5%. Mean age (p=0,001), mean Charlson comorbidity index (p=0,001) and concomitant use of ACE inhibitors (p=0,004) were major predictors of NTX. Being over age 60 was strongly correlated with NTX (p=0.001, OR=5,199). NTX was recovered in 58,1% of the patients, majority(61,5%) of whom within 7 days (median 6,5 days, range 3-105 day) of their hospital stay.

    Conclusion: NTX during colistin use was found to be basically related with advanced age (particularly >60), high comorbidity index, and concomitant use of ACE inhibitors. Initial dose, total dose, or duration of COL treatment, or other accompanying nephrotoxic agents were not among the predictors for NTX.

    Fehmi Tabak, professor1, Ilker Inanc Balkan2, Mustafa Dogan3, Bulent Durdu4, Ayse Batirel5, Ismail Necati Hakyemez6, Birsen Cetin7, Oguz Karabay8, Ibak Gonen9, Ahmet Selim Ozkan10, Muhammed Emin Demirkol11, Sedat Akbas11, Asiye Bahar Kacmaz11, Sami Uzun12, Sukru Aras13 and Ali Mert14, (1)Infectious Diseases, Cerrahpasa Medical Faculty, Istanbul, Turkey, (2)Infectious Diseases, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey, (3)Namik Kemal University Medical Faculty, Tekirdag, Turkey, (4)Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey, (5)Dr Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey, (6)Abant Izzet Baysal University Medical Faculty, Istanbul, Turkey, (7)Koc University Medical Faculty, Istanbul, Turkey, (8)Infectious Diseases, Medicine faculty of Sakarya University, Sakarya, Turkey, (9)Süleyman Demirel University Medical Faculty, Isparta, Turkey, (10)Kırklareli State Hospital, Kirklareli, Turkey, (11)İstanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey, (12)Ordu State Hospital, Ordu, Turkey, (13)İstanbul Ahenk Diagnostics, Istanbul, Turkey, (14)Istanbul Medipol University, Istanbul, Turkey

    Disclosures:

    F. Tabak, None

    I. I. Balkan, None

    M. Dogan, None

    B. Durdu, None

    A. Batirel, None

    I. N. Hakyemez, None

    B. Cetin, None

    O. Karabay, None

    I. Gonen, None

    A. S. Ozkan, None

    M. E. Demirkol, None

    S. Akbas, None

    A. B. Kacmaz, None

    S. Uzun, None

    S. Aras, None

    A. Mert, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.