Colistin is an, antibiotic used to treat carbapenem-resistant Acinetobacter baumannii complex (CRABC) infection. However, colistin is well known for its nephrotoxicity. To accurately assess the effects of colistin on acute kidney injury (AKI) and 28-day mortality, we investigated the risk factors associated with AKI and mortality in patients with CRABC bacteremia who received or never received colistin. Patients with CRABC bacteremia aged ≥18 years were retrospectively identified for 3 years at five tertiary teaching hospitals. AKI was defined by using the Kidney Disease Improving Global Outcomes criteria. AKI developed in 103 (34.9%) of the 295 patients enrolled patients. AKI developed more frequently in patients who received colistin than in patients who did not (46.7% vs. 29.5%, p = 0.004). Multivariate analysis showed that intravenous colistin usage was an independent risk factor for AKI in these patients. Nonfatal disease, catheter-related bloodstream infection, and administration of colistin were protective factors for 28-day mortality. However, the sequential organ failure assessment score and AKI were associated with poor outcomes. In conclusion, colistin may be a double-edged sword; although it causes AKI, it also reduces 28-day mortality in patients with CRABC bacteremia. Therefore, colistin administration as an appropriate antibiotic may improve CRABC bacteremia prognosis, despite its nephrotoxicity.

中文翻译：

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耐碳青霉烯鲍曼不动杆菌复合菌血症急性肾损伤和28天死亡率的预测因素

粘菌素是一种抗生素，用于治疗耐碳青霉烯鲍曼不动杆菌复合体 (CRABC) 感染。然而，粘菌素因其肾毒性而广为人知。为了准确评估粘菌素对急性肾损伤 (AKI) 和 28 天死亡率的影响，我们调查了接受或从未接受粘菌素治疗的 CRABC 菌血症患者中与 AKI 和死亡率相关的危险因素。在 5 家三级教学医院对年龄≥18 岁的 CRABC 菌血症患者进行 3 年的回顾性鉴定。AKI 是通过使用肾脏疾病改善全球结果标准来定义的。在纳入的 295 名患者中，有 103 名 (34.9%) 发生了 AKI。接受粘菌素治疗的患者比未接受粘菌素治疗的患者发生 AKI 的频率更高（46.7% 对 29.5%，p = 0.004）。多变量分析表明，静脉注射粘菌素是这些患者 AKI 的独立危险因素。非致死性疾病、导管相关血流感染和使用粘菌素是 28 天死亡率的保护因素。然而，连续器官衰竭评估评分和 AKI 与不良结局相关。总之，粘菌素可能是一把双刃剑；虽然它会导致 AKI，但它也降低了 CRABC 菌血症患者的 28 天死亡率。因此，粘菌素作为一种合适的抗生素给药可能会改善 CRABC 菌血症的预后，尽管其具有肾毒性。