1518. Systemic Administration of Polymyxin B in Renal Transplant Recipients with Multidrug-resistant Infections and its Associated Nephrotoxicity
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poly B IDSA 2013v4.pdf (330.3 kB)
  • Background:

    Multidrug-resistant organism (MDRO) associated infection is challenging especially for renal transplant recipients (RTR) who have very high mortality.  Historically, polymyxin B (PB) nephrotoxicity has been shown to be 45%-70%, therefore, its use in post RTR can be worrisome.  MDRO associated infections have limited treatment options and often require the use of last-line agent such as PB.  All clinical experience with PB in RTR with MDRO associated infections is limited and needs to be explored.

    Methods:

    Retrospective chart reviews were conducted for adult RTR who received PB ≥ 48 hours for MDRO associated infections.  Patient characteristics, infection type, causative organism, PB regimen, renal function, and concomitant use of nephrotoxic agents (e.g. aminoglycosides) were collected.  Nephrotoxicity was defined as a rise in serum creatinine ≥ 0.5 mg/dL or a ≥ 50% decrease in CrCl from baseline without diagnosis of transplant rejection. Clinical/microbiological outcomes and mortality were evaluated.

    Results:

    A total of 34 RTR (74% male) with a median age of 64 years (range: 40-75 years) were reviewed.  Fifteen patients were on hemodialysis (HD) due to failure of transplant or delayed graft function.  Nineteen non-HD patients with baseline mean CrCl of 60ml/min were included in analysis.  Common infections were bacteremia (37%) and UTI (37%).  Common MDRO were K. pneumoniae (45%) and A. baumanii(15%).  Median duration of PB therapy was 6 days (range: 2-23 days).  Nephrotoxicity occurred in 47% non-HD patients by mean day 6 of PB therapy, however, majority of these patients also received nephrotoxic drug concomitantly.  No patient experienced acute rejection episodes during hospital admission.  Both microbiological clearance and successful clinical outcomes were achieved in 68% of RTR.  Two patients died before discharge and 5 died within 30 days of receiving PB for various reasons.   

    Conclusion:

    Nephrotoxicity with PB therapy in our study (47%) was similar to previously published in the literature.  Given that most episodes of nephrotoxicity were associated with concomitant nephrotoxic drugs, we believe that PB nephrotoxicity rate in RTR could be lower.  Larger studies are needed to more rigorously assess renal toxicity of PB in RTR.

    Quy Huynh, PharmD1, Kwaku Marfo, PharmD1, Philip Chung, PharmD, MS1, Belinda Ostrowsky, MD, MPH2 and Yi Guo, PharmD1, (1)Pharmacy, Montefiore Medical Center, Bronx, NY, (2)Infectious Diseases, Montefiore Medical Center, Bronx, NY

    Disclosures:

    Q. Huynh, None

    K. Marfo, None

    P. Chung, None

    B. Ostrowsky, None

    Y. Guo, None

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