{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T01:43:37Z","timestamp":1790127817201,"version":"4.0.1"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Nephrotoxicity is a known adverse effect of polymyxin antibiotics, including colistin. Although previous meta-analyses have aimed to characterize colistin-associated nephrotoxicity risk relative to other antibiotics, included studies were observational in nature with high risk of confounding and heterogeneity. We conducted this systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to evaluate the incidence of nephrotoxicity associated with colistin versus minimally nephrotoxic antibiotics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed, EMBASE, Cochrane Library, and 3 trial registries for RCTs comparing the nephrotoxicity of colistin to nonpolymyxin antibiotics. Randomized controlled trials that used aminoglycosides were excluded. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The study outcome was the rate of nephrotoxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Five RCTs with a total of 377 patients were included. Most patients received colistin for pneumonia in the intensive care unit, and the comparators were \u03b2-lactam-based regimens. Colistimethate sodium was dosed at 9 million units\/day (300 mg\/day of colistin base activity), with administration of a loading dose in 4 studies. The nephrotoxicity incidence in patients who received colistin was 36.2% (95% CI, 23.3% to 51.3%). The nephrotoxicity rate was significantly higher in the colistin arm than comparators (RR, 2.40; 95% CI, 1.47 to 3.91; P \u2264 .001; I2 = 0%), and the number needed to harm was 5. Findings persisted upon one-study-removed-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This meta-analysis of RCTs found a colistin-associated nephrotoxicity rate of 36.2% and an increase in this risk compared with \u03b2-lactam-based regimens by 140%. Colistin should be regarded as a last-line agent and safer alternatives should be considered when possible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofab026","type":"journal-article","created":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T13:06:59Z","timestamp":1611234419000},"source":"Crossref","is-referenced-by-count":90,"title":["Colistin Nephrotoxicity: Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8355-8637","authenticated-orcid":false,"given":"Khalid","family":"Eljaaly","sequence":"first","affiliation":[{"name":"Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia"},{"name":"College of Pharmacy, University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique R","family":"Bidell","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronak G","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samah","family":"Alshehri","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia"},{"name":"College of Pharmacy, University of Arizona, Tucson, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3145-8036","authenticated-orcid":false,"given":"Mushira A","family":"Enani","sequence":"additional","affiliation":[{"name":"Infectious Diseases Section, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Al-Jedai","sequence":"additional","affiliation":[{"name":"Deputyship of Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia"},{"name":"College of Medicine and Pharmacy, Alfaisal University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd C","family":"Lee","sequence":"additional","affiliation":[{"name":"Clinical Practice Assessment Unit, Department of Medicine, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,1,21]]},"reference":[{"key":"2021021717285597700_CIT0001","doi-asserted-by":"crossref","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":"2021021717285597700_CIT0002","volume-title":"Polymyxin B Product Information","year":"2012"},{"key":"2021021717285597700_CIT0003","doi-asserted-by":"crossref","first-page":"105889","DOI":"10.1016\/j.ijantimicag.2020.105889","article-title":"Is colistin-associated acute kidney injury clinically important in adults? A systematic review and meta-analysis","volume":"55","author":"Chien","year":"2020","journal-title":"Int J Antimicrob Agents"},{"key":"2021021717285597700_CIT0004","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.cmi.2016.05.019","article-title":"Dose and duration of intraventricular antibiotic therapy in meningitis","volume":"22","author":"Eljaaly","year":"2016","journal-title":"Clin Microbiol Infect"},{"key":"2021021717285597700_CIT0005","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.jinf.2008.04.002","article-title":"Efficacy and safety of high-dose ampicillin\/sulbactam vs. colistin as monotherapy for the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia","volume":"56","author":"Betrosian","year":"2008","journal-title":"J Infect"},{"key":"2021021717285597700_CIT0006","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1186\/s13054-019-2627-y","article-title":"Colistin versus meropenem in the empirical treatment of ventilator-associated pneumonia (Magic Bullet study): an investigator-driven, open-label, randomized, noninferiority controlled trial","volume":"23","author":"Cisneros","year":"2019","journal-title":"Crit Care"},{"key":"2021021717285597700_CIT0007","doi-asserted-by":"crossref","first-page":"901","DOI":"10.2217\/cer-2018-0037","article-title":"Meropenem\/colistin versus meropenem\/ampicillin-sulbactam in the treatment of carbapenem-resistant pneumonia","volume":"7","author":"Khalili","year":"2018","journal-title":"J Comp Eff Res"},{"key":"2021021717285597700_CIT0008","first-page":"206","article-title":"Interim study: comparison of safety and efficacy of levofloxacin plus colistin regimen with levofloxacin plus high dose ampicillin\/ sulbactam infusion in treatment of ventilator-associated pneumonia due to multi drug resistant acinetobacter","volume":"16","author":"Mosaed","year":"2018","journal-title":"Iran J Pharm Sci"},{"key":"2021021717285597700_CIT0009","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.1093\/cid\/ciz530","article-title":"RESTORE-IMI 1: A multicenter, randomized, double-blind trial comparing efficacy and safety of imipenem\/relebactam vs colistin plus imipenem in patients with imipenem-nonsusceptible bacterial infections","volume":"70","author":"Motsch","year":"2020","journal-title":"Clin Infect Dis"},{"key":"2021021717285597700_CIT0010","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.diagmicrobio.2018.11.008","article-title":"Nephrotoxicity prevalence in patients treated with polymyxins: a systematic review with meta-analysis of observational studies","volume":"94","author":"Oliota","year":"2019","journal-title":"Diagn Microbiol Infect Dis"},{"key":"2021021717285597700_CIT0011","doi-asserted-by":"crossref","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"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofab026\/35931185\/ofab026.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/8\/2\/ofab026\/36301389\/ofab026.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ofid\/article-pdf\/8\/2\/ofab026\/36301389\/ofab026.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,20]],"date-time":"2021-02-20T13:16:54Z","timestamp":1613827014000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofab026\/6105295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,21]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021,2,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofab026","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,2,1]]},"published":{"date-parts":[[2021,1,21]]},"article-number":"ofab026"}}