Comparison of findings in ICU and non-ICU cohorts is also complicated by the fact that the former patients are likely to be more closely monitored and more rapidly treated than those being Nilotinib order cared for on general wards.Septic shock was the strongest predictor of AKI in our cohort. Many authors agree that the renal effects of sepsis, per se, should not be underestimated. Early AKI is common in septic shock , and it may potentiate the effects of colistin and other drugs on the kidney. The combination of septic shock and AKI had a consistently negative effect on survival. Among the patients with septic shock who did not receive CMS at all (that is, those who were treated with NAs alone), the incidence of AKI was 64% (45/70), which confirms the predominant role of septic shock in the kidney injury (Figure (Figure11).
Limitation of the studyThe main limitation of our study is its retrospective design. This shortcoming is partially compensated for by the large number of patients studied, but it is almost impossible to avoid. A prospective randomized trial would inevitably be associated with ethical problems since for many infections, colistin is the only treatment option.None of the patients received the CMS as empirical therapy and a definitive appropriate therapy was achieved within 36/48 hours. There are no data showing that using CMS as an empiric regimen could reduce the risk of inappropriate therapy and/or could reduce the incidence of septic shock or increase the risk of AKI. These interesting issues should be tested by specific trials.
ConclusionsIn conclusion, in ICU patients with normal baseline renal function who receive CMS and/or NAs, Carfilzomib the incidence of AKI as defined by the RIFLE classification is clearly high – 40%. However, high-dose CMS therapy does not appear to be a risk factor for this outcome. Instead, the development of AKI was strongly correlated with the presence of septic shock and with the severity of the patients’ underlying illness, as reflected by the SAPS II score. These findings suggest that renal protection measures, such as blood volume maintenance, are of utmost importance in critically ill patients with infections that require treatment with CMS.Key messages? The incidence of AKI in critically ill patients without pre-existing renal diseases is strongly correlated with the presence of septic shock and with illness severity.? Compared with other nephrotoxic antimicrobials, high-dose CMS does not appear to increase the risk of new-onset AKI in this setting.