Colistin therapy for nosocomial pneumonia and nephrotoxicity

Colistin is frequently used in the treatment of multidrug-resistant (MDR) Gram-negative pathogens,but may cause nephrotoxicity (NT).This retrospective study evaluated the parameters associated with the development of NT and the effect of NT on prognosis.We evaluated 97 patients (median age 70 years,62 male) who received colistimethate sodium for nosocomial pneumonia with MDR Pseudomonas or Acinetobacter spp.NT was determined by using the standardized RIFLE criteria.Demographic features of the patients;clinical,laboratory and radiological characteristics,development of NT and prognostic factors were recorded.Twenty-two patients were treated with Colomycin (Forest Lab.,UK) and 75 patients received Colimycin (Koçak Pharma,TR).Clinical, bacteriological response in 14 days and overall mortality rates were 61.5%, 74.2%, 61.9% respectively.Lengths of stay in the intensive care unit and hospital were found as 24 (0-132) and 34 (10-141) days.NT occured in 63.9% of patients and mortality rate was higher in these patients (p=0.017).Clinical and bacteriological response rates in 14 days were similar in patients receiving the two brands.Durations of intensive care unit and hospitalization were longer in patients who treated with Colomycin (p=0.013, p=0.025).NT and mortality rates were higher in patients who received Colimycin (p=0.003, p=0.016).Treatment with Colimycin was significantly associated with NT (p=0.005);use of Colimycin and lack of clinical response were found as independent risk factors for mortality (p=0.008, p=0.003).In conclusion;treatment of nosocomial pneumonia due to MDR Gram-negative pathogens with colistin is associated with significant response rates but it has high nephrotoxicity rate and increases mortality.