1803. Risk Factors for Acute Kidney Injury in Patients Treated with Polymyxin B: Experience from 139 Cases at a Tertiary University Hospital in Colombia
Session: Poster Abstract Session: Antibacterial Safety
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • CAG 1803 IDweek 2016.pdf (1.8 MB)
  • Background: The widespread dissemination of MDROs has led to the indiscriminate use of carbapenems agents in our institution. As a result, the rate of carbapenem-resistance of Acinetobacter spp, P. aeruginosa and K.pneumoniae corresponds to 78, 33 and 11%, respectively, leading to the pervasive use of Polymyxin B. Recent reports have shown decreased rates of nephrotoxicity associated with Polymyxin B; yet other factors contributing remain unclear. Herein, we aim to determine the incidence and risk factors associated with acute renal failure (ARF) in a large case-series of patients with infections caused by MDROs, treated with Polymyxin B.

    Methods: A retrospective cohort, with a nested case-control study, of all adult patients who received polymyxin B for more than 48 hours, at a tertiary university hospital in Colombia, (January 2011-June 2015), was performed. ARF was defined by AKIN criteria, measured at 7 days, and at the end of polymyxin B treatment. A univariate and multivariate analysis using Stata 12 was performed to determine independent factors associated with ARF.

    Results: Of 139 patients included in our study, 102 were male with median age of 49 years (IQR:28-64). Ninety-five patients (68.3%) were treated in the ICU; the majority (27%) had intra-abdominal pathology. Sixty-one patients (44%) developed ARF; by AKIN classification: Stage 1: 21(15.1%); Stage 2: 19(13.7%), and stage 3:21(15.1%). The median duration of polymyxin B treatment was 11 days (IQR:8-15) for patients with ARF compared with 14 days (IQR:10-20) days in patients without ARF (p=0,013). In the multivariate analysis, independent risk factors for the development of ARF included: total polymyxin B daily dose (OR=2.19, 95% CI [1.04, 4.64]), length of stay at ICU (OR=1.03, 95% CI [1.00, 1.06]), presence of nosocomial infection (OR=6.43 95% CI [2.12, 19.47]), and vasopressor use (OR=5.38, 95% CI [2.40-12.07]). The overall mortality was higher among patients who developed ARF (58.6%) compared with non-renal failure patients (25.6%) (p = 0,001).

    Conclusion: In this large case series, the rate of acute renal failure associated with polymyxin B therapy was greater than reported in studies from the last decade, and associated with increased mortality. The origin of ARF associated to polymyxin B is likely multifactorial and aggravated by the critically ill state of patients enduring nosocomial infections caused by MDROs.

    Carlos Gomez, MD1, Jackeline Barreto, MD2, Johanna Osorio, MD3, Luis C Alvarez, MD2, Claudia F Samboni, MD2, Jorge a Ramos, RN4, Dagoberto Santofimio, MD5, Yudi S Benavides, MD6, Roso Tellez, MD6 and Lina Candelo, MD2, (1)Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, (2)Departamento De Epidemiologia, Hospital Universitario Neiva, Colombia/ Universidad Surcolombiana, Neiva, Colombia, (3)Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia, (4)Hospital Universitario Neiva, Colombia/ Universidad CES, Medellín – Colombia, Neiva, Colombia, (5)Hospital Universitario Neiva, Colombia/ Universidad Surcolombiana, neiva, Colombia, (6)Hospital Universitario Neiva, Colombia/ Universidad Surcolombiana, Neiva, Colombia

    Disclosures:

    C. Gomez, None

    J. Barreto, None

    J. Osorio, None

    L. C. Alvarez, None

    C. F. Samboni, None

    J. A. Ramos, None

    D. Santofimio, None

    Y. S. Benavides, None

    R. Tellez, None

    L. Candelo, None

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