1806. Comparative nephrotoxicity rates between colistimethate sodium and polymyxin B
Session: Poster Abstract Session: Antibacterial Safety
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Nephrotox CMSvsPB_IDWeek 2016 Poster_FINAL.pdf (241.8 kB)
  • Background: The emergence of multidrug-resistant Gram-negative organisms has led to an increased use of the polymyxins, colistimethate sodium (CMS) and polymyxin B (PMB). We aimed to evaluate the comparative nephrotoxicity rates between CMS and PMB.

    Methods: Retrospective, single-center study of hospitalized patients (pts) who received CMS or PMB for ≥ 48 hours between 1/1/12 and 9/30/15. Pts were excluded if they had end stage renal disease (ESRD) or required renal replacement therapy (RRT) prior to CMS or PMB. Primary outcome was to compare acute kidney injury (AKI) rates as per the RIFLE criteria. Secondary outcomes included time to onset of AKI, risk factors for AKI, clinical and microbiological cure, hospital and infection-related length of stay (LOS), and attributable and 30-day mortality. Statistical analyses were performed using Mann-Whitney U, χ2, student’s t-test or Fisher’s exact test as appropriate. A two-tailed α of ≤ 0.05 was considered statistically significant.

    Results: Ninety one pts (63 CMS and 28 PMB) were included. There was no difference in age between the groups (mean 51±14 years CMS vs 51±17 years PMB; p=0.9). Total daily dose of CMS was 5.1±2.3 mg/kg/day and 3.3±0.4 mg/kg/day of PMB. The rate of AKI was 65% for pts who received CMS vs 54% for pts who received PMB (p=0.35). Renal failure occurred in 22% of pts who received CMS vs 7% of pts who received PMB (p=0.26). Median time to AKI was 3 [2-5] days in pts receiving CMS vs 3 [2-4] days in pts receiving PMB (p=0.71). Median number of concurrent nephrotoxic agents was 1 [1-2] in the CMS group and 1 [1-3] in the PMB group (p=0.83). Cox proportional hazard model demonstrated that vasopressor use was an independent risk factor for AKI (HR 1.87, 95% CI 1.01-3.46). Infection-related LOS was 8 [5-12] days in the CMS group and 7 [6-16] days in the PMB group (p=0.28). Attributable mortality occurred in 27% of pts in the CMS group vs 14% of pts in the PMB group (p=0.18). No significant difference was observed in clinical and microbiological cure, hospital LOS, and 30-day mortality rates.

    Conclusion: No difference in rates of AKI or time to AKI was demonstrated between CMS and PMB. PMB will continue to be the preferred polymyxin agent at our institution. Further studies with larger cohorts are warranted to determine the comparative rates of AKI between CMS and PMB.

    Pavithra Srinivas, PharmD, BCPS1, Stephanie Pouch, MD, MS2, Anthony T. Gerlach, PharmD, BCPS, FCCM, FCCP1, Claire V. Murphy, PharmD, BCPS1, Jessica E. Johnston, MS, MPH1, Debra a. Goff, PharmD, FCCP1 and Karri a. Bauer, PharmD, BCPS1, (1)The Ohio State University Wexner Medical Center, Columbus, OH, (2)Department of Medicine, Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH

    Disclosures:

    P. Srinivas, None

    S. Pouch, None

    A. T. Gerlach, None

    C. V. Murphy, None

    J. E. Johnston, None

    D. A. Goff, None

    K. A. Bauer, None

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