Comparison of ABH development related to the use of colistin in the stage 3 intensive care unit according to RIFLE and KDIGO

Purpose: There are many factors such as pseudomonas aeruginosa, acinetobacter baumannii, klebsiella pneumoniae that develop multiple antibiotic resistance in intensive care infections. Colistin, which remained in the back ground in the 1980s in clinical use due to the nephrotoxicity side effect, has started to be preferred again due to these problematic pathogens and limited antibiotic options. However, the negative effect of colistin on the kidneys limits its use in the clinic. . Method: In our study, retrospectively, patients who were given colistin treatment for more than 48 hours in the DICLE university medical faculty hospitals intensive care ünit between january 2016 and december 2019 were examined from the electronic computer recording system and the files and observation forms obtained from the archive. Patients with and without nephrotoxicity were compared. Nephrotoxicity assessment was done according to RIFLE and KDIGO staging. Results:In our study, 145 patients were evaluated. Renal damage was detected in 78 (58%) of the patients included in our study after the use of colistin. Patients with renal damage were found by eliminating patients without renal damage according to both the RIFLE and KDIGO staging system. Renal damage development was found statistically significant in terms of mortality. Although renal damage development was more common in advanced age patients, no statistical significance was found. There was no significant statistical relationship between colistin-induced renal injury and gender. 45 patients with renal injury had pneumonia. As a result of the statistical analysis, the presence of pneumonia was found significant in terms of the risk of developing renal damage. When we look at the risk factors for the development of renal damage due to colistin use, low basal hemoglobin, basal urea, creatinine, potassium, phosphorus and magnesium levels were found statistically significant. Mortality rates were similar compared to KDIGO and RIFLE staging systems. In terms of mortality, both classifications can be used. Conclusion: We recommend that the KDIGO and RIFLE criteria can be used for mortality estimation, but we recommend using the priority as KDIGO is easier to use and has higher specificity-sensitivity.