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Kolistin ve Akut Böbrek Yetmezliği: Tek Merkez Deneyimi

Colistin and Acute Renal Failure: A Centre’s Experience

Journal Name:

Publication Year:

DOI: 
10.5262/tndt.2014.1003.04

Keywords (Original Language):

Abstract (2. Language): 
OBJECT IVE: Colistin is a polymyxin antibiotic with a polypeptide structure and is effective against gram-negative bacilli. Although its use had decreased due to its side effects, it has increased again in recent years, especially for multi-drug resistant Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter and Enterobacteriaceae. In the present study, patients that received colistin at one center were retrospectively analysed in terms of nephrotoxicity. MATERIAL and METHODS: Patients hospitalized and treated with colistin in the intensive care unit between January 2012 and August 2013 were analyzed. Demographic data; biochemical tests at baseline, daily during hospitalization and after discharge; and the initial, maintenance and total doses of colistin were evaluated. RESULT S: The mean age was 62±13 (31-86) years for the 27 patients with 17 (63%) males that were followed-up for an average duration of 63±89 days. During follow-up, 18 patients (66.7%) developed acute renal failure (ARF) and 17 (63%) of died. There were 12 (66.7%) mortalities in the ARF group and 5 (55%) in the group without ARF ( p> 0.05). The total colistin dose and leukocyte count were higher in the ARF group with 3.75±2.34 g and 12.04±5.05/mm3 than the non-ARF group at 3.32±1.86 g and 7.60±3.7/mm3 but did not reach statistical significance. CONCLU SION: ARF increases the mortality in ICU patients. Although colistin is an effective therapeutic agent used for resistant infections, we have to avoid higher doses due to its potential side effect of ARF.
Abstract (Original Language): 
AMAÇ: Kolistin gram negatif basillerde etkili, polipeptid yapıda bir polimiksin antibiyotiğidir. Geçmişte yan etkileri nedeniyle kullanımı azalmasına karşın son yıllarda özellikle çoklu ilaç direnci olan Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter ve Enterobacteriaceae’da etkinliği olduğundan kullanımı giderek artmaktadır. Bu çalışmada, merkezimizde kolistin kullanılan hastalar nefrotoksisite yönünden retrospektif olarak değerlendirilmiştir. GEREÇ ve YÖNT EML ER: Çalışmaya Ocak 2012– Ağustos 2013 yıllarında 2. basamak yoğun bakım ünitemizde yatarak kolistin tedavisi alan hastalar alındı. Demografik veriler; bazal, yatış sırasında günlük alınan ve taburculuk sonrası bakılan biyokimyasal tetkikler; ve kolistin başlangıç, idame ve toplamda verilen dozları değerlendirildi. BULGUL AR: Yaş ortalaması 62±13 (31-86) yıl olan 17 (%63) erkek, toplam 27 hasta ortalama 63±89 gün izlenmiştir. Tüm izlem süresince hastaların 18’inde (%66,7) akut böbrek yetmezliği (ABY) gelişmiş, 17 (%63) hasta exitus olmuştur. Mortaliteler ABY grubunda 12 (%66,7), ABY olmayan grupta 5’tir (%55) (p> 0,05). Toplam kolistin dozu ve lökosit sayısı istatistiki olarak anlamlılığa ulaşmasa da ABY grubunda 3,75±2,34 g ve 12,04±5,05/mm3 olup ABY olmayan gruptaki 3,32±.1,86 g ve 7,60±3,7/ mm3 değerlerinden daha yüksektir. SONU Ç: Yoğun bakım hastalarında ABY mortaliteyi arttırmaktadır. Kolistin, dirençli enfeksiyonlarda kullanılan etkin bir tedavi ajanı olduğu halde ABY yan etkisi göz önüne alındığında bu ilacın yüksek dozlarda kullanımından mümkün olduğunca kaçınılması doğru bir yaklaşım olacaktır.
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