Renal function profile in patients using polimixin for treatment of multiresistant Pseudomonas sp. in an ICU

Introduction

Multidrug-resistant Pseudomonas sp. (MDR-PS) is one of the most frequently isolated microorganisms causing hospital-acquired infections. Polimixin has been the only therapeutic option in many such cases. Nephrotoxicity is always a concern when this antibiotic is being used.

Objective

The purpose of this study is to describe the impact of Polimixin use in the renal function of a number of patients.

Materials and methods

A retrospective series of cases of patients with infection caused by MDR-PS, after 3 days or more of Polimixin use, admitted from December 2002 to August 2004 to the medical–surgical ICU of a tertiary hospital. The renal function was evaluated using the mean of the serum urea and creatinine obtained before and during the Polimixin use. A total of 31 cases were analyzed. For data analysis, measures of frequency and central tendency were used; the Wilcoxon test for comparison of the means before and during treatment.

Results

The mean age of the patients was 66.52 ± 17.86 years, 67.7% of male gender. The observed co-morbidities were: arterial hypertension 54.8%, malignant neoplasm 35.4%, diabetes mellitus 29.3%, and chronic renal failure (CRF) 19.3%. The length of stay in the ICU was 33.7 ± 28.7 (median 23) days and the average days of Polimixin use was 15.19 ± 10.37 (median 14) days. Eleven patients (35.5%) were on dialysis during the Polimixin use, five cases started the dialysis during the treatment, three of these had CRF. Among the patients not on dialysis, only 18 had urea and creatinine values available for analysis prior to and during the treatment. The total mean for urea prior to and during the treatment was 68.64 ± 49.39 and 69.64 ± 31.90 (P = 0.57) and the total mean for creatinine before and during treatment was 1.57 ± 1.6 and 2.24 ± 3.5 (P = 0.32), respectively.

Conclusions

In this small sample of critically ill patients, the use of Polimixin did not demonstrate a significant impact in renal function as observed by following the urea and creatinine levels.