Yoğun bakımda yatmakta olan hastalarda polimiksin kullanan hastalarla kolistin kullanan hastaların böbrek fonksiyon testlerinin karşılaştırılması
Küçük Resim Yok
Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Tekirdağ Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Yoğun Bakım Ünitelerinde (YBÜ) yatmakta olan hastalarda enfeksiyon hastalıkları, önemli bir mortalite ve morbidite sebebi olarak karşımıza çıkar. Antibiyotiklere karşı bakteriyel direnç de bu duruma katkıda bulunur. Polimiksin B ve kolistin, nefrotoksik ve nörotoksik yan etkileri nedeniyle kullanımı azaltılmış olan, ancak ÇİD mikroorganizmalara karşı etkinlikleri nedeniyle klinikte yeniden yer bulan, lipopeptid yapıda, eski antibiyotiklerdir. Polimiksin B ve kolistin arasında karşılaştırılabilir terapötik etkinliğe ve daha düşük nefrotoksik potansiyele sahip olan ilaç diğerine tercih edilecektir. Çeşitli komorbiditeleri olan YBÜ hastalarında tedavi sırasında ABH geliştirme potansiyelini karşılaştırmak için özel olarak tasarlanmış, yeterli istatistiksel güce sahip bir klinik çalışma halen yoktur. Çalışmamızda 1 Ocak 2017-1 Kasım 2022 tarihleri arasında Tekirdağ Namık Kemal Üniversitesi Araştırma Hastanesi'nde Dahiliye Yoğun Bakım Ünitesi ve Anesteziyoloji ve Reanimasyon Yoğun Bakım Ünitesi'nde yatmış olan hastalar dahil edildi. Kolistin veya polimiksin B uygulanan 18-80 yaş aralığındaki hastaların retrospektif olarak değerlendirilerek böbrek fonksiyon testlerinin ve ABH gelişim oranlarının karşılaştırılması amaçlanmıştır. Çalışmamıza en az 7 gün süreyle antibiyoterapi uygulanmış olan, toplam 158 YBÜ hastası dahil edildi. Bu hastaların, tedavi süresince böbrek fonksiyon testleri ve KDIGO ABH kılavuzunca ABH gelişim oranları, gelişmişse ABH evreleri ve ABH oluşum süreleri, mortalite durumları incelendi. Sonuç olarak, çalışmamızda kolistin uygulanan hastalarda ABH gelişiminin, polimiksin B uygulanan hastalara göre istatistiksel olarak anlamlı düzeyde daha sık olduğu görüldü (p=0,008). ABH gelişen hastalarda hangi günlerde ABH geliştiği incelenerek; 24.saatte gelişenler, 48.saatte gelişenler ve ilk 7 günde gelişenler olmak üzere 3 sınıfa ayrılmıştır. 24.saatte ve ilk 7 günde ABH gelişimi açısından kolistin ve polimiksin B uygulanan hastalar arasında istatistiksel anlamlı fark saptanmazken 48.saatte ABH gelişimi açısından kolistin ve polimiksin B uygulanan hastalar arasında istatistiksel anlamlı fark saptandı (p=0,041). ABH gelişen hastaların, ABH gelişmeyen hastalara göre anlamlı derecede daha yüksek mortaliteye sahip olduğu görüldü (p=0,034). Polimiksin B veya kolistin uygulanıp ABH gelişen hastalarda mortalite oranları arasında istatistiksel olarak anlamlı fark tespit edilmedi (p=0,930).
Infectious diseases are an important cause of mortality and morbidity in patients hospitalized in Intensive Care Units (ICU). Bacterial resistance to antibiotics also contributes to this condition. Polymyxin B and colistin are old antibiotics with a lipopeptide structure, the use of which has been reduced due to their nephrotoxic and neurotoxic side effects, but has found a new place in the clinic due to their effectiveness against MDR microorganisms. The drug with comparable therapeutic efficacy and lower nephrotoxic potential between polymyxin B and colistin would be preferred over the other. There is currently no clinical trial with sufficient statistical power specifically designed to compare the potential for developing AKI during treatment in ICU patients with various comorbidities. In our study, patients who were hospitalized in the Internal Medicine Intensive Care Unit and Anesthesiology and Reanimation Intensive Care Unit at Tekirdağ Namık Kemal University Research Hospital between January 1, 2017 and November 1, 2022 were included. We aimed to compare renal function tests and AKI development rates by retrospectively evaluating patients between the ages of 18-80 who were administered colistin or polymyxin B. A total of 158 ICU patients who received antibiotic therapy for at least 7 days were included in our study. Kidney function tests of these patients during the treatment, AKI development rates according to the KDIGO AKI guideline, AKI stages if developed, duration of AKI formation, and mortality status were examined. As a result, in our study, it was observed that the development of AKI in patients administered colistin was statistically significantly more frequent than in patients administered polymyxin B (p=0.008). By examining on which days AKI developed in patients who developed AKI; they are divided into 3 classes: those that develop in the 24th hour, those that develop in the 48th hour, and those that develop in the first 7 days. While there was no statistically significant difference between the patients treated with colistin and polymyxin B in terms of the development of AKI at the 24th hour and in the first 7 days, a statistically significant difference was detected between the patients treated with colistin and polymyxin B in terms of the development of AKI at the 48th hour (p=0.041). It was observed that patients who developed AKI had a significantly higher mortality than patients who did not develop AKI (p=0.034). No statistically significant difference was detected between the mortality rates in patients who were administered polymyxin B or colistin and developed AKI (p=0.930).
Infectious diseases are an important cause of mortality and morbidity in patients hospitalized in Intensive Care Units (ICU). Bacterial resistance to antibiotics also contributes to this condition. Polymyxin B and colistin are old antibiotics with a lipopeptide structure, the use of which has been reduced due to their nephrotoxic and neurotoxic side effects, but has found a new place in the clinic due to their effectiveness against MDR microorganisms. The drug with comparable therapeutic efficacy and lower nephrotoxic potential between polymyxin B and colistin would be preferred over the other. There is currently no clinical trial with sufficient statistical power specifically designed to compare the potential for developing AKI during treatment in ICU patients with various comorbidities. In our study, patients who were hospitalized in the Internal Medicine Intensive Care Unit and Anesthesiology and Reanimation Intensive Care Unit at Tekirdağ Namık Kemal University Research Hospital between January 1, 2017 and November 1, 2022 were included. We aimed to compare renal function tests and AKI development rates by retrospectively evaluating patients between the ages of 18-80 who were administered colistin or polymyxin B. A total of 158 ICU patients who received antibiotic therapy for at least 7 days were included in our study. Kidney function tests of these patients during the treatment, AKI development rates according to the KDIGO AKI guideline, AKI stages if developed, duration of AKI formation, and mortality status were examined. As a result, in our study, it was observed that the development of AKI in patients administered colistin was statistically significantly more frequent than in patients administered polymyxin B (p=0.008). By examining on which days AKI developed in patients who developed AKI; they are divided into 3 classes: those that develop in the 24th hour, those that develop in the 48th hour, and those that develop in the first 7 days. While there was no statistically significant difference between the patients treated with colistin and polymyxin B in terms of the development of AKI at the 24th hour and in the first 7 days, a statistically significant difference was detected between the patients treated with colistin and polymyxin B in terms of the development of AKI at the 48th hour (p=0.041). It was observed that patients who developed AKI had a significantly higher mortality than patients who did not develop AKI (p=0.034). No statistically significant difference was detected between the mortality rates in patients who were administered polymyxin B or colistin and developed AKI (p=0.930).
Açıklama
Tıp Fakültesi, İç Hastalıkları Ana Bilim Dalı
Anahtar Kelimeler
İç Hastalıkları, Internal diseases
