• Christine J Kubin, Tanya M Ellman, Varun Phadke, Laura J Haynes, David P Calfee, and Michael T Yin.
• Department of Pharmacy, New York-Presbyterian Hospital, 630 W. 168th Street, New York, NY 10032, USA. cck27@columbia.edu
• J. Infect. 2012 Jul 1; 65 (1): 80-7.

BackgroundIncreases in multidrug-resistance among gram-negative organisms have necessitated the use of polymyxins. To date, the incidence of acute kidney injury (AKI) associated with polymyxin B has not been evaluated using RIFLE criteria.MethodsAdult patients who received polymyxin B were retrospectively evaluated to determine the incidence of AKI during polymyxin B therapy using RIFLE criteria. Predictors of AKI were identified by comparing characteristics of patients with and without AKI.ResultsA total of 73 patients were included. The incidence of AKI was 60%. Ten (14%) patients discontinued therapy due to nephrotoxicity. Median duration of polymyxin B was 11 days with a median cumulative dose of 18 mg/kg. Concomitant nephrotoxins were received in 69 (95%). Patients with AKI had a higher median cumulative dose (1578 mg vs. 800 mg; p = 0.02), a higher body mass index (BMI) (27.2 vs. 24.5 kg/m(2); p = 0.03), and were more likely to receive vancomycin (82% vs. 55%; p = 0.03) compared to those without AKI. After controlling for polymyxin B duration, independent predictors of AKI were higher BMI and concomitant vancomycin.ConclusionsThe incidence of AKI during polymyxin B therapy was 60%. Further studies are needed to define dosing parameters that maximize efficacy and minimize nephrotoxicity.Copyright © 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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