Colistin effectiveness and nephrotoxicity: experience from a tertiary care burns unit in Oman

Background The emergence of multiple drug-resistant (MDR) Gram-negative bacteria and the lack of new antibiotics to combat them have led to the revival of colistin, a drug which was abandoned because of its toxicity. Recent reports showed the drug is effective and relatively safe in burns patients. In this article, we present our experience with the drug. Methods A retrospective study over a period of 2 years was carried out. Forty-eight patients treated with colistin were reviewed and the outcome and nephrotoxicity were assessed. Results The most prevalent MDR organism in our burns unit was Acinetobacter species. MDR Pseudomonas aeruginosa was seen in few cases and it was always associated with Acinetobacter species infection. The maximum cumulative dose was 193,000,000 international units. The maximum duration was 45 days. The mortality was 33.3 %. Renal function test impairment or worsening was seen in 14 patients (29%). There was no statistically significant impairment of renal function. The P value for creatinine was 0.1236. Conclusions Colistin is useful for treating multidrug-resistant organism infections in burns patients when no alternative is available. Renal impairment is a major side effect of this antibiotic and the risk maybe higher in burns patients because the burn itself can cause acute kidney injury.