Development of a Prediction Model for Acute Kidney Injury after Colistin Treatment for Multidrug-resistant Acinetobacter baumanii Ventilator-Associated Pneumonia: A Pilot Study
DOI:
https://doi.org/10.31584/jhsmr.2022891Keywords:
acute kidney injury, colistin, prediction model, ventilator-associated pneumoniaAbstract
Objective: Multidrug-resistant Acinetobacter baumanii (MDR-AB) ventilator-associated pneumonia (VAP) is the major complication following hospital admission in Thailand, increasing morbidity and prolonging hospital stay duration. Treatment of MDR-AB VAP usually requires colistin which has highly nephrotoxic properties. Therefore, we aimed to develop a pilot prediction model for acute kidney injury (AKI) after colistin treatment.
Material and Methods: We conducted a retrospective cohort study. All MDR-AB VAP patients who received colistin for at least 72 hours in Suratthani Hospital from January to July 2017 were eligible for inclusion. The primary outcome was the overall presence of AKI on days 3, 5 or 7 after colistin administration. Multivariable logistic regression analysis was used to develop the final prediction model.
Results: Of 85 MDR-AB VAP patients, 51 (61%) developed AKI after colistin treatment. Nine factors, female, intensive care unit (ICU) admission, diabetes mellitus, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum sodium, creatinine, blood urea nitrogen (BUN) and glomerular filtration rate were potential predictors of AKI. Multivariable logistic regression with backward stepwise selection revealed the best prediction model had four predictors: female, ICU admission, BUN, and DBP. The area under the receiver operating characteristic curve for the model in predicting AKI among MDR-AB VAP patients was 0.801 (95% confidence interval: 0.703, 0.898).
Conclusion: The prediction model containing four predictors, female gender, ICU admission, BUN level, and DBP had fair to good performance in predicting AKI after colistin treatment among MDR-AB VAP patients.
References
Kalanuria AA, Ziai W, Mirski M. Ventilator-associated pneumonia in the ICU. Crit Care 2014;18:208.
Poolkumlang Y, Pommachat W, Siripanich P, Pramprawat S, Disayabutr S. Effect of 72-hour versus weekly changes of in-line suction catheters on rates of ventilator-associated pneumonia. J Med Assoc Thai 2019;102:745-9.
Kanjanawasri S, Gulgusol N, Manapatanasatein T, Yeepho T. A Study of ventilator-associated pneumonia in King Narai Hospital. J Med Assoc Thai 2018;101:1720-6.
Singh H, Thangaraj P, Chakrabarti A. Acinetobacter baumannii: a brief account of mechanisms of multidrug resistance and current and future therapeutic management. J Clin Diagn Res 2013;7:2602-5.
Durakovic N, Radojcic V, Boban A, Mrsic M, Sertic D, Serventi Seiwerth R, et al. Efficacy and safety of colistin in the treatment of infections caused by multidrug-resistant Pseudomonas aeruginosa in patients with hematologic malignancy: a matched pair analysis. Intern Med 2011;50:1009-13.
Ordooei Javan A, Shokouhi S, Sahraei Z. A review on colistin nephrotoxicity. Eur J Clin Pharmacol 2015;71:801-10.
Cikman A, Gulhan B, Aydin M, Ceylan MR, Parlak M, Karakecili F, et al. In vitro activity of colistin in combination with tigecycline against carbapenem-resistant Acinetobacter baumannii strains isolated from patients with ventilator-associated pneumonia. Int J Med Sci 2015;12:695-700.
Balkan II, Dogan M, Durdu B, Batirel A, Hakyemez IN, Cetin B, et al. Colistin nephrotoxicity increases with age. Scand J Infect Dis 2014;46:678-85.
Gauthier TP, Wolowich WR, Reddy A, Cano E, Abbo L, Smith LB. Incidence and predictors of nephrotoxicity associated with intravenous colistin in overweight and obese patients. Antimicrob Agents Chemother 2012;56:2392-6.
Pogue JM, Lee J, Marchaim D, Yee V, Zhao JJ, Chopra T, et al. Incidence of and risk factors for colistin-associated nephrotoxicity in a large academic health system. Clin Infect Dis 2011;53:879-84. 11. Kwon J-A, Lee JE, Huh W, Peck KR, Kim Y-G, Kim DJ, et al. Predictors of acute kidney injury associated with intravenous colistin treatment. Int J Antimicrob Agents 2010;35:473-7.
Kwon KH, Oh JY, Yoon Y-S, Jeong Y-J, Kim KS, Shin SJ, et al. Colistin treatment in carbapenem-resistant Acinetobacter baumannii pneumonia patients: incidence of nephrotoxicity and outcomes. Int J Antimicrob Agents 2015;45:605-9.
Miano TA, Lautenbach E, Wilson FP, Guo W, Borovskiy Y, Hennessy S. Attributable risk and time course of colistin associated acute kidney injury. Clin J Am Soc Nephrol 2018;13:542-50.
Koksal I, Kaya S, Gencalioglu E, Yilmaz G. Evaluation of risk factors for intravenous colistin use-related nephrotoxicity. Oman Med J 2016;31:318-21.
Korkmaz Ekren P, Töreyin ZN, Berk Takır H, Kalamanoğlu Balcı M, Gaygısız Ü, Gürsel G, et al. Evaluation of nephrotoxicity and prognosis in patients treated with colistin due to hospital acquired pneumonia. Tuberk Toraks 2017;65:271-81.
Durante-Mangoni E, Andini R, Signoriello S, Cavezza G, Murino P, Buono S, et al. Acute kidney injury during colistin therapy: a prospective study in patients with extensively-drug resistant Acinetobacter baumannii infections. Clin Microbiol Infect 2016;22:984-9.
Dalfino L, Puntillo F, Ondok MJM, Mosca A, Monno R, Coppolecchia S, et al. Colistin-associated acute kidney injury in severely ill patients: a step toward a better renal care? A prospective cohort study. Clin Infect Dis 2015;61:1771-7.
Katip W, Uitrakul S, Oberdorfer P. Clinical efficacy and nephrotoxicity of the loading dose colistin for the treatment of carbapenem-resistant Acinetobacter baumannii in critically ill patients. Pharmaceutics 2022;14:31.
Rocco M, Montini L, Alessandri E, Venditti M, Laderchi A, De Gennaro P, et al. Risk factors for acute kidney injury in critically ill patients receiving high intravenous doses of colistin methanesulfonate and/or other nephrotoxic antibiotics: a retrospective cohort study. Crit Care 2013;17:R174.
Tanita MT, Carrilho CM, Garcia JP, Festti J, Cardoso LT, Grion CM. Parenteral colistin for the treatment of severe infections: a single center experience. Rev Bras Ter Intensiva 2013;25:297-305. 21. Omrani AS, Alfahad WA, Shoukri MM, Baadani AM, Aldalbahi S, Almitwazi AA, et al. High dose intravenous colistin methanesulfonate therapy is associated with high rates of nephrotoxicity; a prospective cohort study from Saudi Arabia. Ann Clin Microbiol Antimicrob 2015;14:3.
Samrah S, Bashtawi Y, Hayajneh W, Almomani B, Momany S, Khader Y. Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii. J Infect Dev Ctries 2016;10:1129-34.
Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med 2015;162:W1-73.
Timsit J-F, Esaied W, Neuville M, Bouadma L, Mourvllier B. Update on ventilator-associated pneumonia. F1000Res 2017; 6:2061.
Nachnani S, Scuteri A, Newman MG, Avanessian AB, Lomeli SL. E-test: a new technique for antimicrobial susceptibility testing for periodontal microorganisms. J Periodontol 1992;63:576-83. 26. Michalopoulos AS, Karatza DC. Multidrug-resistant Gram negative infections: the use of colistin. Expert Rev Anti Infect Ther 2010;8:1009-17.
Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1-138.
Nation RL, Garonzik SM, Li J, Thamlikitkul V, Giamarellos Bourboulis EJ, Paterson DL, et al. Updated US and European dose recommendations for intravenous colistin: how do they perform? Clin Infect Dis 2016;62:552-8.
Akajagbor DS, Wilson SL, Shere-Wolfe KD, Dakum P, Charurat ME, Gilliam BL. Higher incidence of acute kidney injury with intravenous colistimethate sodium compared with polymyxin B in critically ill patients at a tertiary care medical center. Clin Infect Dis 2013;57:1300-3.
Jiang F, Chen YH, Liang XL, Xu LX, Ma GP, Hu PH, et al. The sensitivity and accuracy of RIFLE and AKIN criteria for acute kidney injury diagnosis in intensive care unit patients. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2011;23:759-62.
Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz A-C, et al. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care 2013;17:R278.
Thomas ME, Blaine C, Dawnay A, Devonald MAJ, Ftouh S, Laing C, et al. The definition of acute kidney injury and its use in practice. Kidney Int Suppl 2015;87:62-73.
Neugarten J, Golestaneh L. Female sex reduces the risk of hospital-associated acute kidney injury: a meta-analysis. BMC Nephrol 2018;19:314.
Hutchens MP, Dunlap J, Hurn PD, Jarnberg PO. Renal ischemia: does sex matter? Anesth Analg 2008;107:239-49.
Uchino S, Bellomo R, Goldsmith D. The meaning of the blood urea nitrogen/creatinine ratio in acute kidney injury. Clin Kidney J 2012;5:187-91.
Forrest A, Garonzik SM, Thamlikitkul V, Giamarellos-Bourboulis EJ, Paterson DL, Li J, et al. Pharmacokinetic/toxicodynamic analysis of colistin-associated acute kidney injury in critically ill patients. Antimicrob Agents Chemother 2017;61:e01367-17.
Sangthawan P, Geater AF, Naorungroj S, Nikomrat P, Nwabor OF, Chusri S. Characteristics, influencing factors, predictive scoring system, and outcomes of the patients with nephrotoxicity associated with administration of intravenous colistin. Antibiotics 2021;11. doi:10.3390/antibiotics11010002.
Nation R, Rigatto M, Falci D, Zavascki A. Polymyxin acute kidney injury: dosing and other strategies to reduce toxicity. Antibiotics 2019;8:24.
Falagas ME, Fragoulis KN, Kasiakou SK, Sermaidis GJ, Michalopoulos A. Nephrotoxicity of intravenous colistin: a prospective evaluation. Int J Antimicrob Agents 2005;26:504-7.
Sorlí L, Luque S, Grau S, Berenguer N, Segura C, Montero MM, et al. Trough colistin plasma level is an independent risk factor for nephrotoxicity: a prospective observational cohort study. BMC Infect Dis 2013;13:380.
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