Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B
Autor(a) principal: | |
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Data de Publicação: | 2018 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações do UNIOESTE |
Texto Completo: | http://tede.unioeste.br/handle/tede/3697 |
Resumo: | In the last 20 years, with the emergence of multiresistant gram-negative bacteria, polymyxins, which had fallen into disuse due to their high toxicity, were once again used as an alternative for the treatment of these infections. This antibiotic group is active against most enterobacteria and non-fermenting gram-negative bacteria, ocular, urinary tract, meninges, and bloodstream infections. The recommended dose of polymyxin B (PMB) in patients with normal renal function is 1.5 to 2.5 mg.kg-1.day-1 and the dose can be divided twice. For patients with impaired renal function, it is recommended to adjust the dose according to creatinine clearance. Because nephrotoxicity is the major limiting factor in the use of this class of antibiotics, a retrospective observational study was conducted to identify possible risk factors for the development of acute renal injury (ARF) in patients using the antibiotic PMB. The necessary information was collected to perform the study in medical records, medical prescriptions and results of laboratory tests from the patients who used PMB in a period of 5 years in a Brazilian hospital. Inclusion criteria for the study were: patients over 18 years of age who used intravenous PMB for more than 72 hours. To classify ARI levels, baseline creatinine was calculated by the average of the last five serum creatinine tests before the first dose of the antibiotic. This calculated value and the highest level of serum creatinine during treatment were used to identify and classify renal damage according to the criteria of the RIFLE (Risk, Injury and Failure and Loss and End-stage renal disease) filtration rate. The study included 120 patients, most of them male (89; 74.2%) with an average age of 50 years. The most frequent pre-existing comorbidities were systemic hypertension (50; 41.7%), diabetes mellitus (21; 17.5%), nephropathies (14; 11.7%) and obesity (13; 10.8%). The main infection was pneumonia (35.8%) and the most frequently identified infectious agent was Acinetobacter baumannii (67.9%). PMB treatments were performed for 13 days and the average daily dose was 191.5 mg. The high incidence of mortality in the studied population (46.7%) may be related to the critical clinical status of the patients, because at some point of hospitalization, 111 patients (92.5%) needed intensive care. In the population studied to evaluate risk factors, 12 patients (13.5%) presented risk, 22 (25.0%) injury, 30 (34.1%) renal failure, according to RIFLE criteria. In addition, in the group that patients developed ARF, 51.9% died, whereas in the group that did not present, only 12.5% died. There was a statistically significant difference between the groups that developed or not ARF, for the following variables: treatment time greater than 10 days, accumulated PMB dose, hypoalbuminemia and concomitant use of furosemide. However, the variables that remained in the final multivariate logistic regression model were treatment time greater than 10 days and hypoalbuminemia. Several factors inherent to the patient and the drug are related to ARF and strategies should be created in order to minimize these effects. The monitoring of renal function in all patients, especially those at risk, and the follow-up of the infection to reduce the time of treatment are highlighted. |
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Sanches , Andréia Cristina Conegerohttp://lattes.cnpq.br/9706216109598342Possagno, Gerusa Clazer Halilahttp://lattes.cnpq.br/7847718094072958Castor, Lidyane Regina Gomeshttp://lattes.cnpq.br/7636348133382791Possagno, Gerusa Clazer Halilahttp://lattes.cnpq.br/7847718094072958http://lattes.cnpq.br/0289242554344598Moresco, Isabel Cristina2018-05-24T17:46:39Z2018-03-08MORESCO, Isabel Cristina. Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B. 2018. 46 f. Dissertação ( Mestrado em Ciências Farmacêuticas) - Universidade Estadual do Oeste do Paraná, Cascavel, 2018.http://tede.unioeste.br/handle/tede/3697In the last 20 years, with the emergence of multiresistant gram-negative bacteria, polymyxins, which had fallen into disuse due to their high toxicity, were once again used as an alternative for the treatment of these infections. This antibiotic group is active against most enterobacteria and non-fermenting gram-negative bacteria, ocular, urinary tract, meninges, and bloodstream infections. The recommended dose of polymyxin B (PMB) in patients with normal renal function is 1.5 to 2.5 mg.kg-1.day-1 and the dose can be divided twice. For patients with impaired renal function, it is recommended to adjust the dose according to creatinine clearance. Because nephrotoxicity is the major limiting factor in the use of this class of antibiotics, a retrospective observational study was conducted to identify possible risk factors for the development of acute renal injury (ARF) in patients using the antibiotic PMB. The necessary information was collected to perform the study in medical records, medical prescriptions and results of laboratory tests from the patients who used PMB in a period of 5 years in a Brazilian hospital. Inclusion criteria for the study were: patients over 18 years of age who used intravenous PMB for more than 72 hours. To classify ARI levels, baseline creatinine was calculated by the average of the last five serum creatinine tests before the first dose of the antibiotic. This calculated value and the highest level of serum creatinine during treatment were used to identify and classify renal damage according to the criteria of the RIFLE (Risk, Injury and Failure and Loss and End-stage renal disease) filtration rate. The study included 120 patients, most of them male (89; 74.2%) with an average age of 50 years. The most frequent pre-existing comorbidities were systemic hypertension (50; 41.7%), diabetes mellitus (21; 17.5%), nephropathies (14; 11.7%) and obesity (13; 10.8%). The main infection was pneumonia (35.8%) and the most frequently identified infectious agent was Acinetobacter baumannii (67.9%). PMB treatments were performed for 13 days and the average daily dose was 191.5 mg. The high incidence of mortality in the studied population (46.7%) may be related to the critical clinical status of the patients, because at some point of hospitalization, 111 patients (92.5%) needed intensive care. In the population studied to evaluate risk factors, 12 patients (13.5%) presented risk, 22 (25.0%) injury, 30 (34.1%) renal failure, according to RIFLE criteria. In addition, in the group that patients developed ARF, 51.9% died, whereas in the group that did not present, only 12.5% died. There was a statistically significant difference between the groups that developed or not ARF, for the following variables: treatment time greater than 10 days, accumulated PMB dose, hypoalbuminemia and concomitant use of furosemide. However, the variables that remained in the final multivariate logistic regression model were treatment time greater than 10 days and hypoalbuminemia. Several factors inherent to the patient and the drug are related to ARF and strategies should be created in order to minimize these effects. The monitoring of renal function in all patients, especially those at risk, and the follow-up of the infection to reduce the time of treatment are highlighted.Nos últimos 20 anos, com o surgimento de bactérias gram-negativas multirresistentes, as polimixinas, que tinham caído em desuso pela elevada toxicidade, voltaram a ser utilizadas como uma alternativa para tratamento dessas infecções. Esse grupo de antibiótico é ativo contra a maioria das enterobactérias e das bactérias gram-negativas não fermentadoras, em infecções oculares, do trato urinário, das meninges e da corrente sanguínea. A dose recomendada de polimixina B (PMB), em pacientes com função renal normal, é de 1,5 a 2,5 mg Kg-1 dia-1 e a dose pode ser dividida em duas vezes. Para os pacientes com alteração da função renal, recomenda-se ajustar a dose de acordo com a depuração de creatinina. Como a nefrotoxicidade é o maior limitante do uso dessa classe de antibióticos, um estudo observacional retrospectivo foi realizado com o objetivo de identificar os possíveis fatores de risco para o desenvolvimento de injúria renal aguda (IRA) em pacientes que utilizaram o antibiótico PMB. Foram coletadas as informações necessárias para realizar o estudo em prontuários, prescrições médicas e resultados de exames laboratoriais dos pacientes que utilizaram PMB em um período de 5 anos em um hospital brasileiro. Os critérios de inclusão para o estudo foram: pacientes maiores de 18 anos que utilizaram PMB por via endovenosa por mais de 72 horas. Para classificar os níveis de IRA, a creatinina basal foi calculada pela média entre os cinco últimos exames de creatinina sérica antes da primeira dose do antibiótico. Esse valor calculado e o maior nível de creatinina sérica durante o tratamento foram usados para identificar e classificar o dano renal segundo os critérios da taxa de filtração glomerular de RIFLE (Risk, Injury and Failure and Loss, and End-stage renal disease). Foram inclusos no estudo 120 pacientes, a maioria do sexo masculino (89; 74,2%) com média de idade de 50 anos. As comorbidades pré-existentes presentes com maior frequência foram hipertensão arterial sistêmica (50; 41,7%), diabetes mellitus (21; 17,5%) nefropatias (14; 11,7%) e obesidade (13; 10,8%). A principal infecção tratada foi pneumonia (35,8%) e o agente infeccioso mais identificado foi o Acinetobacter baumannii (67,9%). Os tratamentos com a PMB foram realizados durante 13 dias e a dose média diária de 191,5 mg. A alta incidência de mortalidade da população estudada (46,7%) pode estar relacionada ao estado clínico crítico dos pacientes, pois, em algum momento do internamento, 111 pacientes (92,5%) precisaram de cuidados intensivos. Na população estudada para avaliar os fatores de risco, 12 pacientes (13,5%) apresentam risco, 22 (25,0%) injúria, 30 (34,1%) falência renal, segundo os critérios de RIFLE. Além disso, no grupo que os pacientes desenvolveram IRA, 51,9% foram a óbito, enquanto que no grupo que não apresentou foram apenas 12,5%. Houve diferença estatisticamente significativa entre os grupos que desenvolveram, ou não, IRA, para as seguintes variáveis: tempo de tratamento superior a 10 dias, dose acumulada de PMB, hipoalbuminemia e uso concomitante de furosemida. Porém, as variáveis que permaneceram no modelo final de regressão logística multivariável foram o tempo de tratamento superior a 10 dias e a hipoalbuminemia. Vários fatores inerentes ao paciente e à droga estão relacionados à IRA e estratégias devem ser criadas com o intuito de minimizar esses efeitos. Destacam-se a monitorização da função renal em todos os pacientes, principalmente os de risco, e o acompanhamento da infecção para diminuir o tempo de tratamento.Submitted by Rosangela Silva (rosangela.silva3@unioeste.br) on 2018-05-24T17:46:38Z No. of bitstreams: 2 Isabel Cristina Moresco.pdf: 778049 bytes, checksum: 0c5c3dc6a4ac6f42d2f9a40313cd38c6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2018-05-24T17:46:39Z (GMT). No. of bitstreams: 2 Isabel Cristina Moresco.pdf: 778049 bytes, checksum: 0c5c3dc6a4ac6f42d2f9a40313cd38c6 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-08application/pdfpor6588633818200016417500Universidade Estadual do Oeste do ParanáCascavelPrograma de Pós-Graduação em Ciências FarmacêuticasUNIOESTEBrasilCentro de Ciências Médicas e Farmacêuticashttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessEstudo observacionalInjúria renal agudaIRAReação adversaRAMRIFLEObservational studyAcute kidney injuryAKIAdverse reactionADRCIENCIAS DA SAUDE::FARMACIAFatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina BRisk factors associated with nephrotoxicity in patients treated with polymyxin Binfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesis7878055067573953101600600600-89404397133878492676997636413449754996reponame:Biblioteca Digital de Teses e Dissertações do UNIOESTEinstname:Universidade Estadual do Oeste do Paraná (UNIOESTE)instacron:UNIOESTEORIGINALIsabel Cristina Moresco.pdfIsabel Cristina Moresco.pdfapplication/pdf778049http://tede.unioeste.br:8080/tede/bitstream/tede/3697/5/Isabel+Cristina+Moresco.pdf0c5c3dc6a4ac6f42d2f9a40313cd38c6MD55CC-LICENSElicense_urllicense_urltext/plain; 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dc.title.por.fl_str_mv |
Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B |
dc.title.alternative.eng.fl_str_mv |
Risk factors associated with nephrotoxicity in patients treated with polymyxin B |
title |
Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B |
spellingShingle |
Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B Moresco, Isabel Cristina Estudo observacional Injúria renal aguda IRA Reação adversa RAM RIFLE Observational study Acute kidney injury AKI Adverse reaction ADR CIENCIAS DA SAUDE::FARMACIA |
title_short |
Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B |
title_full |
Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B |
title_fullStr |
Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B |
title_full_unstemmed |
Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B |
title_sort |
Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B |
author |
Moresco, Isabel Cristina |
author_facet |
Moresco, Isabel Cristina |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Sanches , Andréia Cristina Conegero |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/9706216109598342 |
dc.contributor.referee1.fl_str_mv |
Possagno, Gerusa Clazer Halila |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/7847718094072958 |
dc.contributor.referee2.fl_str_mv |
Castor, Lidyane Regina Gomes |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/7636348133382791 |
dc.contributor.referee3.fl_str_mv |
Possagno, Gerusa Clazer Halila |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/7847718094072958 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/0289242554344598 |
dc.contributor.author.fl_str_mv |
Moresco, Isabel Cristina |
contributor_str_mv |
Sanches , Andréia Cristina Conegero Possagno, Gerusa Clazer Halila Castor, Lidyane Regina Gomes Possagno, Gerusa Clazer Halila |
dc.subject.por.fl_str_mv |
Estudo observacional Injúria renal aguda IRA Reação adversa RAM RIFLE |
topic |
Estudo observacional Injúria renal aguda IRA Reação adversa RAM RIFLE Observational study Acute kidney injury AKI Adverse reaction ADR CIENCIAS DA SAUDE::FARMACIA |
dc.subject.eng.fl_str_mv |
Observational study Acute kidney injury AKI Adverse reaction ADR |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::FARMACIA |
description |
In the last 20 years, with the emergence of multiresistant gram-negative bacteria, polymyxins, which had fallen into disuse due to their high toxicity, were once again used as an alternative for the treatment of these infections. This antibiotic group is active against most enterobacteria and non-fermenting gram-negative bacteria, ocular, urinary tract, meninges, and bloodstream infections. The recommended dose of polymyxin B (PMB) in patients with normal renal function is 1.5 to 2.5 mg.kg-1.day-1 and the dose can be divided twice. For patients with impaired renal function, it is recommended to adjust the dose according to creatinine clearance. Because nephrotoxicity is the major limiting factor in the use of this class of antibiotics, a retrospective observational study was conducted to identify possible risk factors for the development of acute renal injury (ARF) in patients using the antibiotic PMB. The necessary information was collected to perform the study in medical records, medical prescriptions and results of laboratory tests from the patients who used PMB in a period of 5 years in a Brazilian hospital. Inclusion criteria for the study were: patients over 18 years of age who used intravenous PMB for more than 72 hours. To classify ARI levels, baseline creatinine was calculated by the average of the last five serum creatinine tests before the first dose of the antibiotic. This calculated value and the highest level of serum creatinine during treatment were used to identify and classify renal damage according to the criteria of the RIFLE (Risk, Injury and Failure and Loss and End-stage renal disease) filtration rate. The study included 120 patients, most of them male (89; 74.2%) with an average age of 50 years. The most frequent pre-existing comorbidities were systemic hypertension (50; 41.7%), diabetes mellitus (21; 17.5%), nephropathies (14; 11.7%) and obesity (13; 10.8%). The main infection was pneumonia (35.8%) and the most frequently identified infectious agent was Acinetobacter baumannii (67.9%). PMB treatments were performed for 13 days and the average daily dose was 191.5 mg. The high incidence of mortality in the studied population (46.7%) may be related to the critical clinical status of the patients, because at some point of hospitalization, 111 patients (92.5%) needed intensive care. In the population studied to evaluate risk factors, 12 patients (13.5%) presented risk, 22 (25.0%) injury, 30 (34.1%) renal failure, according to RIFLE criteria. In addition, in the group that patients developed ARF, 51.9% died, whereas in the group that did not present, only 12.5% died. There was a statistically significant difference between the groups that developed or not ARF, for the following variables: treatment time greater than 10 days, accumulated PMB dose, hypoalbuminemia and concomitant use of furosemide. However, the variables that remained in the final multivariate logistic regression model were treatment time greater than 10 days and hypoalbuminemia. Several factors inherent to the patient and the drug are related to ARF and strategies should be created in order to minimize these effects. The monitoring of renal function in all patients, especially those at risk, and the follow-up of the infection to reduce the time of treatment are highlighted. |
publishDate |
2018 |
dc.date.accessioned.fl_str_mv |
2018-05-24T17:46:39Z |
dc.date.issued.fl_str_mv |
2018-03-08 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
MORESCO, Isabel Cristina. Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B. 2018. 46 f. Dissertação ( Mestrado em Ciências Farmacêuticas) - Universidade Estadual do Oeste do Paraná, Cascavel, 2018. |
dc.identifier.uri.fl_str_mv |
http://tede.unioeste.br/handle/tede/3697 |
identifier_str_mv |
MORESCO, Isabel Cristina. Fatores de risco associados à nefrotoxicidade em pacientes Tratados com polimixina B. 2018. 46 f. Dissertação ( Mestrado em Ciências Farmacêuticas) - Universidade Estadual do Oeste do Paraná, Cascavel, 2018. |
url |
http://tede.unioeste.br/handle/tede/3697 |
dc.language.iso.fl_str_mv |
por |
language |
por |
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Universidade Estadual do Oeste do Paraná Cascavel |
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Programa de Pós-Graduação em Ciências Farmacêuticas |
dc.publisher.initials.fl_str_mv |
UNIOESTE |
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Brasil |
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Centro de Ciências Médicas e Farmacêuticas |
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Universidade Estadual do Oeste do Paraná Cascavel |
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