Characteristics, Influencing Factors, Predictive Scoring System, and Outcomes of the Patients with Nephrotoxicity Associated with Administration of Intravenous Colistin

Multidrug-resistant Gram-negative infection is a major global public health threat. Currently, colistin is considered the last-resort treatment despite its nephrotoxicity. The purpose of this study was to estimate the incidence, characteristics, and influencing factors and to develop a prediction model for colistin-associated nephrotoxicity. A retrospective study was conducted in the university hospital in the South of Thailand from December 2015 to June 2019. A total of 381 patients (median age (IQR) of 64 (51-62) years) were analyzed. Overall, 282 (74%) had nephrotoxicity according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification. In-hospital, 30-day mortality rates and cost of hospital admission were significantly higher among those with nephrotoxicity. Age > 60 years, comorbidities, serum albumin less than 3.5 g/dL, and concomitant nephrotoxic use were significantly associated with colistin-associated nephrotoxicity with adjusted OR (95% CI) 2.01 (1.23-2.45), 1.85 (1.18-3.6), 1.68 (1.09-2.99), and 1.77 (1.10-2.97), respectively. The prediction model for high-risk colistin-associated nephrotoxicity was identified with good overall performance (specificity of 79.6% (95% CI 70.3-87.1) and positive predictive value of 92.1% (95% CI 88.0-95.1)). In conclusion, the incidence of colistin-associated nephrotoxicity was high and incurred significant morbidity, mortality, and economic burden. Our predictive scoring system is relatively simple and useful for optimizing colistin therapy.