Acute Kidney Injury Related to Intravenous Colistin Use in Lebanese Hospitalized Patients: Incidence and Associated Factors

Background: Colistin use has increased because of the emergence of infections caused by resistant gram-negative bacteria. Acute kidney injury (AKI) remains a treatment-limiting factor for widespread colistin clinical use. This study aimed at determining the incidence and the factors associated with the development of colistin-induced AKI. Methods: A retrospective observational study was conducted by reviewing files of adult patients with normal kidney function between January 2015 to March 2019 at a university hospital located in Beirut city. AKI was defined based on KDIGO criteria. Independent variables associated with colistin-induced AKI were also tested. Results: In this study, a total of 113 patients were included. AKI occurred in 53 patients (46.9%). The Charlson Comorbidity Index (CCI) was found to be significantly greater in the AKI group (2.26, P-value = 0.026). In the multivariate analysis, low serum albumen was found as an independent significant predictor for AKI (OR=.065, 95%CI: .013-.337, P-value=0.001). Moreover, the risk for AKI increased by 2 folds (OR=2.019, 95%CI: 1.094-3.728, P-value: 0.025), when two or more nephrotoxic agents were administered simultaneously with colistin. The patient's age was also found as a significant predictor for AKI (OR=1.034, 95%CI:1-1.07), with a cut-off value of 58.5-year-old. Conclusion: This study demonstrated that the concomitant use of two or more nephrotoxic drugs, patient's age of 58.5 or above, and the presence of hypoalbuminemia were independent factors for the development of colistin-induced AKI. These factors should be therefore taken into consideration when prescribing colistin in clinical practice to decrease the risk of AKI.