Colistin Nephrotoxicity: Meta-analysis of Randomized Controlled Trials

摘要: Background Nephrotoxicity is a known adverse effect of polymyxin antibiotics, including colistin. Although previous meta-analyses have aimed to characterize colistin-associated nephrotoxicity risk relative other included studies were observational in nature with high confounding and heterogeneity. We conducted this systematic review meta-analysis exclusively randomized controlled trials (RCTs) evaluate the incidence associated colistin versus minimally nephrotoxic antibiotics. Methods searched PubMed, EMBASE, Cochrane Library, 3 trial registries for RCTs comparing nonpolymyxin Randomized that used aminoglycosides excluded. Risk ratios (RRs) 95% confidence intervals (CIs) calculated using random-effects models. The study outcome was rate nephrotoxicity. Results Five total 377 patients included. Most received pneumonia intensive care unit, comparators β-lactam-based regimens. Colistimethate sodium dosed at 9 million units/day (300 mg/day base activity), administration loading dose 4 studies. who 36.2% (95% CI, 23.3% 51.3%). significantly higher arm than (RR, 2.40; 1.47 3.91; P ≤ .001; I2 = 0%), number needed harm 5. Findings persisted upon one-study-removed-analysis. Conclusions This found an increase compared regimens by 140%. Colistin should be regarded as last-line agent safer alternatives considered when possible.