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Intravenous Colistin Therapy for Multidrug-Resistant Gram-Negative Bacterial Infections in Major Burn Injuries
Journal of Korean Burn Society 2019;22(1):1-9
Published online June 1, 2019
© 2019 Journal of Korean Burn Society.

Gi yuon Cho, M.D.1, Jaechul Yoon, M.D., Jin Woo Chun, M.D., Youngmin Kim, M.D., Haejun Yim, M.D., Dohern Kym, M.D., Jun Hur, M.D., Wook Chun, M.D. and Yong Suk Cho, M.D.

Department of Burn Surgery, Hangang Sacred Heart Hospital, Hallym University, Seoul, 1Department of Surgery, Dongtan Sacred Heart Hsopital, College of Medicine, Hallym University, Hwaseong, Korea
Correspondence to: Yong Suk Cho, Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, 12 Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul 07247, Korea Tel: 82-2-2639-5442, Fax: 82-2-2678-4386, E-mail: maruchigs@hallym.or.kr
Received April 4, 2019; Revised May 14, 2019; Accepted May 22, 2019.
Abstract
Purpose: The aim of this study was to investigate the characteristics of Acute Kidney Injury Network (AKIN)-defined nephrotoxicity in patients undergoing intravenous colistimethate sodium (CMS) therapy for major burns.
Methods: This retrospective study included burn patients who received more than 48 h of intravenous CMS between September 2009 and December 2015. Data collection was performed using the institution’s electronic medical record system. Patients assigned to the developed nephrotoxic group experienced aggravation of current AKIN stage during CMS treatment; those assigned to the non-nephrotoxic group experienced no change in current or exhibited improved AKIN stage during CMS therapy.
Results: A total of 306 patients were included in this study. All patients were grouped according to AKIN stage: AKIN 0 (n=152); AKIN 1 (n=6); AKIN 2 (n=9); AKIN 3 (n=139). The baseline creatinine (Cr) level was 0.73 mg/dL. The incidence of nephrotoxicity was 50.3% according to AKIN stage; overall mortality was 45.8%. The non-nephrotoxic group consisted of 127 (74.7%) patients and 43 (25.3%) were in the developed nephrotoxic group. In patients requiring continuous renal replacement therapy (CRRT), baseline Cr level was 0.83 mg/dL, pre-CMS Cr level was 1.17 mg/dL, and post-CMS Cr level was 1.34 mg/dL. 
Conclusion: CMS can be administered without signs of nephrotoxicity for a certain period (approximately 1 week), it can be used relatively safely for 2 weeks. Application of CMS is a reasonable option for treating infections caused by multi-drug resistant gram-negative bacteria in patients with major burns. The caution should be exercised nevertheless.
Keywords : Major burn, Colistin, Multidrug resistant, Nephrotoxic


June 2019, 22 (1)
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