중환자에서 Colistimethate 정맥내 투여와 관련된 급성 신손상에 대한 연구

Objective: Colistimethate was first became available in 1950s and used until the early 1980s to treat infections causedby gram-negative bacteria and was abandoned due to its nephrotoxicity and neurotoxicity. However, it was recently reintroducedinto the clinical practices due to emergence of multidrug-resistance gram-negative bacteria, particularlyPseudomonas aeruginosa and Acinetobacter baumanii. Therefore, it is increasingly used in the intensive care unit settingsas a salvage therapy. This study was designed to investigate the incidence rates and risk factors of acute kidneyinjury associated with colistimethate by using the standardized definition in critically ill patients. Methods: This studyretrospectively reviewed the electronic medical records of 71 adult patients above 18 years old receiving intravenouscolistimethate at least 48 hours at intensive care unit, university-affiliated hospital from Nov 2012 to Aug 2013 andexcluded patients with end-stage renal disease (ESRD) and required renal replacement therapy before initiation of thecolistimethate therapy. Acute kidney injury (AKI) was determined by using the standardized RIFLE criteria, classifiedwith risk, injury, failure, loss and ESRD according to serum creatinine (Scr) levels. Results: Among the 71 patientsincluded in the analysis, AKI developed in 40 patients (56.3%) and 6 patients (8.4%) had irreversible kidney injury. AKIoccurred within 5 days in 20 patients (50.0%). Maximum Scr level showed a significant increase in the patients with AKI(1.92±0.86 mg/dL vs. 1.12±0.46 mg/dL p=0.001), maximum BUN also increased (64.2±28.7 mg/dL vs. 48.4±24.9 mg/dLp=0.017) and minimum creatinine clearance (CLcr) was significantly decreased in the patients with AKI than non-AKI(34.5±18.6 ml/min vs. 64.4±33.7 ml/min p=0.185). The patients with AKI had significantly longer duration of colistimethatetherapy (21.1±17.0 days vs. 13.0±11.5 days, p=0.020) and larger cumulative doses of colistimethate (6465.9±4717.0 mg vs. 4438.1±3426.7 mg, p=0.040). Conclusion: The incidence and severity of AKI associated with colistimethatein critically ill patients was high and serious. Drug monitoring program should be performed to shorten durationof therapy and reduce cumulative dose from initiation of colistimethate therapy for minimizing AKI of colistimethate.