J Korean Burn Soc.  2019 Jun;22(1):1-9. 10.0000/jkbs.2019.22.1.1.

Intravenous Colistin Therapy for Multidrug-Resistant Gram-Negative Bacterial Infections in Major Burn Injuries

Affiliations
  • 1Department of Burn Surgery, Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea. maruchigs@hallym.or.kr
  • 2Department of Surgery, Dongtan Sacred Heart Hsopital, College of Medicine, Hallym University, Hwaseong, Korea.

Abstract

PURPOSE
The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns.
METHODS
This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution's electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy.
RESULTS
A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL.
CONCLUSION
CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.

Keyword

Major burn; Colistin; Multidrug resistant; Nephrotoxic
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