Purpose: In recent years, the emergence of multidrug-resistant (MDR) microorganisms had caused the resurgence of colistin use afterit was previously abandoned due to its side effects, nephrotoxicity in particular. However, the specific incidence of colistin-inducednephrotoxicity varies in reports with different populations. This study aims to assess the incidence of colistin-associated nephrotoxicityand the associated risk factors.Patients and Methods: This study was on 178 patients who received colistin for more than 48 hours during the years 2019–2022,who were followed up for 14 days after the initiation of colistin, and demographic and clinical data were gained from medical reports.Logistic regression was used to assess the relationship between nephrotoxicity and study variables.Results: The incidence of nephrotoxicity was 44.9% (95% confidence interval (CI); 37% to 53%), and the overall mortality was 33%,with a significantly higher level among patients with nephrotoxicity. The significant risk factors for nephrotoxicity after adjustmentwere; higher weights (OR = 1.1, 95% CI; 0.03–1.2), P-value: 0.006, and the combination with carbapenem showed a significantprotective effect (OR = 0.09, 95% CI; 0.01–0.8), P-value: 0.03. The severity, according to KDIGO classification, was stage 1 (47%),stage 2 (21%), and stage 3 (31%). Higher stages had earlier onset acute kidney injury, a lower percentage of returning to baseline, andexposure to a higher colistin dose.Conclusion: Colistin-induced nephrotoxicity was a frequent issue associated with higher weights, mitigated by the combination withcarbapenems. While higher colistin dosages, and earlier onset AKI, were linked to the progression to higher AKI stages and the needfor dialysis.Keywords: acute kidney injury, nephrotoxicity, colistin, multi-drug resistance organismsIntroductionColistin belongs to the family of polymyxin, which is a cationic polypeptide, that can interact with the bacteria’s outermembrane, leading to cell wall destruction, and subsequently destroying the organism. It was first discovered in the late1940s and had FDA approval in 1962. 1 However, it was abandoned shortly after its marketing began, after the risingreports of potentially serious adverse events, in terms of nephrotoxicity and neurotoxicity. However, since the beginningof the 21st century, colistin use has resurged, chiefly due to the emergence of gram-negative multi-drug resistanceorganisms, including Pseudomonas aeruginosa, Klebsiella Pneumoniae, Enterobacteriaceae, and Acinetobacterbaumannii. 2,3The reintroduction of this compound was after the proven effectiveness and less toxicity than was reported in olderstudies. The reason for the lower rate of toxicity in recent studies compared to previous ones, from a side, is due to theInfection and Drug Resistance 2023:16 3007–3017 3007© 2023 Rabi et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.phpand incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the workyou hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Forpermission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).Infection and Drug Resistance Dovepressopen access to scientific and medical researchOpen Access Full Text ArticleReceived: 24 February 2023Accepted: 28 April 2023Published: 15 May 2023

Title

Infection and Drug Resistance

Publisher

Taylor & Francis

Publisher Country

United Kingdom

Publication Type

Both (Printed and Online)

Volume

16

Year

2024

Pages

3007-3017