Clinical outcomes and nephrotoxicity of colistin methanesulfonate in critically ill patients with carbapenem-resistant organisms infections: a retrospective study

Background Carbapenem resistant organisms (CRO) infection is one of the most common causes of high mortality among critically ill patients. Colistin methanesulfonate (CMS) represents a significant treatment option for CRO infections, yet the available data on CMS in the Chinese population remains limited. This study aimed to analyze the clinical outcomes and nephrotoxicity of CMS in treating critically ill patients with CRO infections in China. Methods A retrospective study was conducted from June 2022 to September 2023 in critically ill patients with CRO infections who received CMS treatment. The clinical outcomes were assessed by clinical effective, microbiological eradication, infection-related hospital mortality, the length of ICU stay, and total hospital stay. A sub-group analysis was conducted on patients with lung infection. The nephrotoxicity was assessed by the acute kidney injury (AKI). Results A total of 96 critically ill patients with CRO infections were enrolled in the study. The overall clinical effective, microbiological eradication and infection-related hospital mortality rates were 67.90%, 60.49% and 8.33%, respectively. The median length of ICU and total hospital stays was 28 and 32.5 days, respectively. In patients with lung infection, 70.31% and 61.19% achieved clinical effective and microbiological eradication, respectively. The younger patients (< 65 years old), patients who received intravenous combined nebulized CMS, and infections caused by CRE benefitted more from CMS treatment. The incidence of acute kidney injury (AKI) was 28 cases (30.43%), with the majority (82.14%) occurring in stage 1. Conclusions CMS treatment in Chinese critically ill patients with CRO infections achieved favorable outcomes, with acceptable nephrotoxicity, providing a promising option for this fatal disease.