Abstract

A CASE REPORT ON COLISTIN-INDUCED ACUTE KIDNEY INJURY AND DYSELECTROLYTEMIA IN A TERTIARY CARE HOSPITAL

Lekshmi Gopal U., Dr. Jibinamol Jose*, Delna Davis, Dr. Remyasri Akhil and Dr. J. J. Mathew

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Abstract

Background: Colistin is a last-resort antibiotic used for multidrugresistant (MDR) infections. However, its use is often limited by nephrotoxicity and electrolyte imbalances. Case Presentation: A 65- year-old male presented with cough, whitish expectoration, and breathing difficulty. He had a recent history of lower respiratory tract infection (LRTI) treated at a local hospital. Initially, he was started on piperacillin-tazobactam (4.5g every 8 hours), but his C-reactive protein (CRP) levels remained elevated from day 4 of admission. Sputum culture revealed heavy growth of MDR Escherichia coli, with susceptibility to gentamicin and intermediate sensitivity to colistin. Based on the physician’s clinical judgment, colistin (4.5 million units, twice daily) was initiated. On the 12th day of colistin therapy, the patient developed acute kidney injury (AKI), with serum creatinine rising from 0.6 mg/dL to 1.7 mg/dL, along with severe dyselectrolytemia. Colistin was discontinued, leading to renal recovery. Conclusion: This case highlights colistin-induced nephrotoxicity and dyselectrolytemia as significant adverse effects, emphasizing the need for careful monitoring and judicious use of colistin in MDR infections.

Keywords: Colistin-induced nephrotoxicity, Acute kidney injury, Dyselectrolytemia, Bronchiectasis, MDR- E.coli infection.