RESUMEN
Purpose: In recent years, the emergence of multidrug-resistant (MDR) microorganisms had caused the resurgence of colistin use after it was previously abandoned due to its side effects, nephrotoxicity in particular. However, the specific incidence of colistin-induced nephrotoxicity varies in reports with different populations. This study aims to assess the incidence of colistin-associated nephrotoxicity and the associated risk factors. Patients and Methods: This study was on 178 patients who received colistin for more than 48 hours during the years 2019-2022, who were followed up for 14 days after the initiation of colistin, and demographic and clinical data were gained from medical reports. Logistic regression was used to assess the relationship between nephrotoxicity and study variables. Results: The incidence of nephrotoxicity was 44.9% (95% confidence interval (CI); 37% to 53%), and the overall mortality was 33%, with a significantly higher level among patients with nephrotoxicity. The significant risk factors for nephrotoxicity after adjustment were; higher weights (OR = 1.1, 95% CI; 0.03-1.2), P-value: 0.006, and the combination with carbapenem showed a significant protective effect (OR = 0.09, 95% CI; 0.01-0.8), P-value: 0.03. The severity, according to KDIGO classification, was stage 1 (47%), stage 2 (21%), and stage 3 (31%). Higher stages had earlier onset acute kidney injury, a lower percentage of returning to baseline, and exposure to a higher colistin dose. Conclusion: Colistin-induced nephrotoxicity was a frequent issue associated with higher weights, mitigated by the combination with carbapenems. While higher colistin dosages, and earlier onset AKI, were linked to the progression to higher AKI stages and the need for dialysis.
RESUMEN
BACKGROUND: Postoperative nausea and vomiting (PONV) and postoperative pain (POP) are most commonly experienced in the early hours after surgery. Many studies have reported high rates of PONV and POP, and have identified factors that could predict the development of these complications. This study aimed to evaluate the relationship between PONV and POP, and to identify some factors associated with these symptoms. METHODS: This was a prospective, multicentre, observational study performed at An-Najah National University Hospital and Rafidia Governmental Hospital, the major surgical hospitals in northern Palestine, from October 2019 to February 2020. A data collection form, adapted from multiple previous studies, was used to evaluate factors associated with PONV and POP in patients undergoing elective surgery. Patients were interviewed during the first 24 h following surgery. Multiple binary logistic regression was applied to determine factors that were significantly associated with the occurrence of PONV. RESULTS: Of the 211 patients included, nausea occurred in 43.1%, vomiting in 17.5%, and PONV in 45.5%. Multiple binary logistic regression analysis, using PONV as a dependent variable, showed that only patients with a history of PONV [odds ratio (OR) = 2.28; 95% confidence interval (CI) = 1.03-5.01; p = 0.041] and POP (OR = 2.41; 95% CI = 1.17-4.97; p = 0.018) were significantly associated with the occurrence of PONV. Most participants (74.4%) reported experiencing pain at some point during the first 24 h following surgery. Additionally, the type and duration of surgery were significantly associated with POP (p-values were 0.002 and 0.006, respectively). CONCLUSIONS: PONV and POP are common complications in our surgical patients. Factors associated with PONV include a prior history of PONV and POP. Patients at risk should be identified, the proper formulation of PONV protocols should be considered, and appropriate management plans should be implemented to improve patients' outcomes.
