{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:22:20Z","timestamp":1790799740167,"version":"4.1.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Polymyxins are last-resort antibiotics for multidrug-resistant Gram-negative infections, but their nephrotoxicity limits clinical use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the nephrotoxicity of colistin versus polymyxin B and identify risk factors for acute kidney injury (AKI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed 258 patients (132 colistin, 126 polymyxin B) with normal to moderately impaired renal function. Machine learning (ML) algorithms predicted AKI risk, and propensity score matching was used to evaluate the risk of colistin preference over polymyxin B.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Colistin nephrotoxicity (defined as at least stage II KDIGO AKI) was significantly more frequent with colistin than polymyxin B in both unmatched (for colistin 31% versus for polymyxin B 19%, P\u200a=\u200a0.04) and matched cohorts (34.4% for colistin versus 14.1% for polymyxin B, P\u200a=\u200a0.01). ML identified lower baseline eGFR, higher uric acid, hypalbuminaemia, higher age, concomitant nephrotoxic drug use, weight, vasopressor use and polymyxin type as top predictors. Colistin preference over polymyxin B resulted in significant nephrotoxicity risk in both unmatched (OR: 2.08, 95% CI [1.14\u20133.79]) and matched cohorts (OR: 3.42, 95% CI [1.38\u20138.5]). Complete renal recovery occurred in only 41% of AKI cases within 30\u2005days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Colistin demonstrates significantly higher nephrotoxicity than polymyxin B. The complex relationship between baseline renal function and AKI risk suggests careful monitoring for patients with moderate renal impairment, regardless of polymyxin choice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jac\/dkag044","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T12:40:41Z","timestamp":1769604041000},"source":"Crossref","is-referenced-by-count":3,"title":["Comparative nephrotoxicity of polymyxin B versus colistin: evidence from ensemble learning and propensity score matching"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6981-1210","authenticated-orcid":false,"given":"Murat","family":"\u00d6zdede","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hacettepe University Faculty of Medicine , Ankara ,","place":["T\u00fcrkiye"]},{"name":"School of Cardiovascular and Metabolic Medicine & Sciences, King's College London , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma Nisa","family":"Balli Turhan","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Gazi University Faculty of Pharmacy , Ankara ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zgenur","family":"Gerid\u00f6nmez","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy , Ankara ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emre","family":"Kara","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy , Ankara ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2676-4557","authenticated-orcid":false,"given":"G\u00f6khan","family":"Metan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine , Ankara ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"2026060105020577900_dkag044-B1","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1146\/annurev.bi.46.070177.003451","article-title":"Polymyxin and related peptide antibiotics","volume":"46","author":"Storm","year":"1977","journal-title":"Annu Rev Biochem"},{"key":"2026060105020577900_dkag044-B2","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1016\/S1473-3099(06)70580-1","article-title":"Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections","volume":"6","author":"Li","year":"2006","journal-title":"Lancet Infect Dis"},{"key":"2026060105020577900_dkag044-B3","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1111\/j.1469-0691.2004.01043.x","article-title":"Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic","volume":"11","author":"Michalopoulos","year":"2005","journal-title":"Clin Microbiol Infect"},{"key":"2026060105020577900_dkag044-B4","doi-asserted-by":"publisher","first-page":"R27","DOI":"10.1186\/cc3995","article-title":"Toxicity of polymyxins: a systematic review of the evidence from old and recent studies","volume":"10","author":"Falagas","year":"2006","journal-title":"Crit Care"},{"key":"2026060105020577900_dkag044-B5","doi-asserted-by":"publisher","first-page":"4503","DOI":"10.1128\/AAC.01707-09","article-title":"Colistin dosing and nephrotoxicity in a large community teaching hospital","volume":"54","author":"DeRyke","year":"2010","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060105020577900_dkag044-B6","doi-asserted-by":"publisher","first-page":"1724","DOI":"10.1086\/599225","article-title":"Nephrotoxicity associated with intravenous colistin (colistimethate sodium) treatment at a tertiary care medical center","volume":"48","author":"Hartzell","year":"2009","journal-title":"Clin Infect Dis"},{"key":"2026060105020577900_dkag044-B7","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1016\/j.diagmicrobio.2009.07.018","article-title":"Polymyxin B and colistimethate are comparable as to efficacy and renal toxicity","volume":"65","author":"Oliveira","year":"2009","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2026060105020577900_dkag044-B8","doi-asserted-by":"publisher","first-page":"7795096","DOI":"10.1155\/2021\/7795096","article-title":"Colistin-induced acute kidney injury and the effect on survival in patients with multidrug-resistant Gram-negative infections: significance of drug doses adjusted to ideal body weight","volume":"2021","author":"Arrayasillapatorn","year":"2021","journal-title":"Int J Nephrol"},{"key":"2026060105020577900_dkag044-B9","doi-asserted-by":"publisher","first-page":"449","DOI":"10.4103\/ijn.IJN_130_20","article-title":"Colistin nephrotoxicity-age and baseline kidney functions hold the key","volume":"31","author":"Prasannan","year":"2021","journal-title":"Indian J Nephrol"},{"key":"2026060105020577900_dkag044-B10","doi-asserted-by":"publisher","first-page":"e0173286","DOI":"10.1371\/journal.pone.0173286","article-title":"Defining the incidence and risk factors of colistin-induced acute kidney injury by KDIGO criteria","volume":"12","author":"Shields","year":"2017","journal-title":"PLoS One"},{"key":"2026060105020577900_dkag044-B11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s12941-018-0262-0","article-title":"Comparison of nephrotoxicity of Colistin with Polymyxin B administered in currently recommended doses: a prospective study","volume":"17","author":"Aggarwal","year":"2018","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"2026060105020577900_dkag044-B12","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.3390\/antibiotics12081317","article-title":"Comparison between Colistin and Polymyxin B in the treatment of bloodstream infections caused by Carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii-calcoaceticus complex","volume":"12","author":"Garcia","year":"2023","journal-title":"Antibiotics"},{"key":"2026060105020577900_dkag044-B13","doi-asserted-by":"publisher","first-page":"2443","DOI":"10.1128\/AAC.02634-15","article-title":"Multicenter prospective cohort study of renal failure in patients treated with Colistin versus Polymyxin B","volume":"60","author":"Rigatto","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060105020577900_dkag044-B14","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.ijantimicag.2016.07.023","article-title":"Colistin versus Polymyxin B for the treatment of patients with multidrug-resistant Gram-negative infections: a systematic review and meta-analysis","volume":"49","author":"Vardakas","year":"2017","journal-title":"Int J Antimicrob Agents"},{"key":"2026060105020577900_dkag044-B15","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1186\/s12879-023-08339-0","article-title":"Comparative study of polymyxin B and colistin sulfate in the treatment of severe comorbid patients infected with CR-GNB","volume":"23","author":"Wang","year":"2023","journal-title":"BMC Infect Dis"},{"key":"2026060105020577900_dkag044-B16","doi-asserted-by":"publisher","first-page":"107031","DOI":"10.1016\/j.ijantimicag.2023.107031","article-title":"Acute kidney injury associated with colistin sulfate vs. polymyxin B sulfate therapy: a real-world, retrospective cohort study","volume":"63","author":"Zhang","year":"2024","journal-title":"Int J Antimicrob Agents"},{"key":"2026060105020577900_dkag044-B17","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1186\/s12879-025-10773-1","article-title":"Efficacy and safety of polymyxin B sulfate versus colistin sulfate in ICU patients with nosocomial pneumonia caused by carbapenem-resistant Acinetobacter baumannii: a multicenter, propensity score-matched, real-world cohort study","volume":"25","author":"Bu","year":"2025","journal-title":"BMC Infect Dis"},{"key":"2026060105020577900_dkag044-B18","doi-asserted-by":"publisher","first-page":"107175","DOI":"10.1016\/j.ijantimicag.2024.107175","article-title":"Machine learning algorithms to predict colistin-induced nephrotoxicity from electronic health records in patients with multidrug-resistant Gram-negative infection","volume":"64","author":"Chiu","year":"2024","journal-title":"Int J Antimicrob Agents"},{"key":"2026060105020577900_dkag044-B19","doi-asserted-by":"publisher","first-page":"107035","DOI":"10.1016\/j.ijantimicag.2023.107035","article-title":"Battle of polymyxin induced nephrotoxicity: polymyxin B versus colistin","volume":"63","author":"Ball\u0131","year":"2024","journal-title":"Int J Antimicrob Agents"},{"key":"2026060105020577900_dkag044-B20","doi-asserted-by":"publisher","first-page":"1737","DOI":"10.1056\/NEJMoa2102953","article-title":"New creatinine- and cystatin C\u2013based equations to estimate GFR without race","volume":"385","author":"Inker","year":"2021","journal-title":"N Engl J Med"},{"key":"2026060105020577900_dkag044-B21","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1053\/j.ackd.2019.08.001","article-title":"Nephrotoxicity of antimicrobials and antibiotics","volume":"27","author":"Morales-Alvarez","year":"2020","journal-title":"Adv Chronic Kidney Dis"},{"key":"2026060105020577900_dkag044-B22","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1002\/phar.2209","article-title":"International consensus guidelines for the optimal use of the polymyxins: endorsed by the American college of clinical pharmacy (ACCP), European society of clinical microbiology and infectious diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP)","volume":"39","author":"Tsuji","year":"2019","journal-title":"Pharmacotherapy"},{"key":"2026060105020577900_dkag044-B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/cc11454","article-title":"Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)","volume":"17","author":"Kellum","year":"2013","journal-title":"Crit Care"},{"key":"2026060105020577900_dkag044-B24","doi-asserted-by":"publisher","first-page":"2392","DOI":"10.1128\/AAC.00028-12","article-title":"Incidence and predictors of nephrotoxicity associated with intravenous colistin in overweight and obese patients","volume":"56","author":"Gauthier","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060105020577900_dkag044-B25","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1592\/phco.27.8.1081","article-title":"Antimicrobial dosing considerations in obese adult patients","volume":"27","author":"Pai","year":"2007","journal-title":"Pharmacotherapy"},{"key":"2026060105020577900_dkag044-B26","doi-asserted-by":"publisher","first-page":"53","DOI":"10.4274\/mjima.galenos.2021.2021.53","article-title":"Colistin induced nephrotoxicity: experience from a university hospital","volume":"10","author":"Ekinci","year":"2021","journal-title":"Mediter J Infect Microbes Antimicrob"},{"key":"2026060105020577900_dkag044-B27","doi-asserted-by":"publisher","first-page":"11968","DOI":"10.1038\/s41598-018-30361-5","article-title":"Hypoalbuminemia as a predictor of acute kidney injury during colistin treatment","volume":"8","author":"Giacobbe","year":"2018","journal-title":"Sci Rep"},{"key":"2026060105020577900_dkag044-B28","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.ijantimicag.2009.12.002","article-title":"Predictors of acute kidney injury associated with intravenous colistin treatment","volume":"35","author":"Kwon","year":"2010","journal-title":"Int J Antimicrob Agents"},{"key":"2026060105020577900_dkag044-B29","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12941-015-0062-8","article-title":"High dose intravenous colistin methanesulfonate therapy is associated with high rates of nephrotoxicity; a prospective cohort study from Saudi Arabia","volume":"14","author":"Omrani","year":"2015","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"2026060105020577900_dkag044-B30","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1038\/s41598-022-04862-3","article-title":"Prognostic value of hyperuricemia for patients with sepsis in the intensive care unit","volume":"12","author":"Liu","year":"2022","journal-title":"Sci Rep"},{"key":"2026060105020577900_dkag044-B31","doi-asserted-by":"publisher","first-page":"6319","DOI":"10.1128\/AAC.00254-13","article-title":"Megalin contributes to kidney accumulation and nephrotoxicity of colistin","volume":"57","author":"Suzuki","year":"2013","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060105020577900_dkag044-B32","doi-asserted-by":"publisher","first-page":"2136","DOI":"10.1128\/AAC.04869-14","article-title":"Major pathways of polymyxin-induced apoptosis in rat kidney proximal tubular cells","volume":"59","author":"Azad","year":"2015","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060105020577900_dkag044-B33","doi-asserted-by":"publisher","first-page":"1766","DOI":"10.1128\/AAC.47.5.1766-1770.2003","article-title":"Use of high-performance liquid chromatography to study the pharmacokinetics of colistin sulfate in rats following intravenous administration","volume":"47","author":"Li","year":"2003","journal-title":"Antimicrob Agents Chemother"},{"key":"2026060105020577900_dkag044-B34","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1038\/nm.3762","article-title":"Defective fatty acid oxidation in renal tubular epithelial cells has a key role in kidney fibrosis development","volume":"21","author":"Kang","year":"2015","journal-title":"Nat Med"},{"key":"2026060105020577900_dkag044-B35","doi-asserted-by":"publisher","first-page":"F82","DOI":"10.1152\/ajprenal.00091.2008","article-title":"Silencing megalin and cubilin genes inhibits myeloma light chain endocytosis and ameliorates toxicity in human renal proximal tubule epithelial cells","volume":"295","author":"Li","year":"2008","journal-title":"Am J Physiol Renal Physiol"},{"key":"2026060105020577900_dkag044-B36","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1038\/ki.2012.62","article-title":"Acute endotoxemia in mice induces downregulation of megalin and cubilin in the kidney","volume":"82","author":"Schreiber","year":"2012","journal-title":"Kidney Int"},{"key":"2026060105020577900_dkag044-B37","doi-asserted-by":"publisher","first-page":"318","DOI":"10.7883\/yoken.JJID.2014.223","article-title":"Incidence and risk factors for colistin-associated nephrotoxicity","volume":"68","author":"Temocin","year":"2015","journal-title":"Jpn J Infect Dis"},{"key":"2026060105020577900_dkag044-B38","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.ijantimicag.2013.12.002","article-title":"Risk factors for acute kidney injury in patients treated with polymyxin B or colistin methanesulfonate sodium","volume":"43","author":"Tuon","year":"2014","journal-title":"Int J Antimicrob Agents"},{"key":"2026060105020577900_dkag044-B39","doi-asserted-by":"publisher","first-page":"2740","DOI":"10.1128\/AAC.02476-13","article-title":"In vitro assessment and multicenter cohort study of comparative nephrotoxicity rates associated with colistimethate versus polymyxin B therapy","volume":"58","author":"Phe","year":"2014","journal-title":"Antimicrob Agents Chemotherapy"},{"key":"2026060105020577900_dkag044-B40","doi-asserted-by":"publisher","first-page":"105328","DOI":"10.1016\/j.phrs.2020.105328","article-title":"Polymyxin-induced nephrotoxicity and its predictors: a systematic review and meta-analysis of studies conducted using RIFLE criteria of acute kidney injury","volume":"163","author":"Sisay","year":"2021","journal-title":"Pharmacol Res"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/81\/6\/dkag044\/68269379\/dkag044.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/81\/6\/dkag044\/68269379\/dkag044.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T09:02:15Z","timestamp":1780304535000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/doi\/10.1093\/jac\/dkag044\/8676064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":40,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,5,5]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkag044","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,5,5]]},"article-number":"dkag044"}}