Double-edged Knife: Can Colistin Nephrotoxicity be Prevented with High Doses of Vitamin C?

Introduction: In this study, it was aimed to determine the risk factors for developing acute kidney injury (AKI) and effects of ascorbic acid on the development of nephrotoxicity in patients receiving systemic colistin sodium therapy. Materials and Methods: We retrospectively reviewed records of cases who were treated with systemic colistin sodium and did not have any known renal disease in our hospital between the years of 2014 and 2019. The demographic characteristics, indications for systemic colistin, other antibiotics applied and nephrotoxic drugs, vasopressor necessity, daily creatinine values, development of acute kidney injury, and ascorbic acid use were evaluated. Acute kidney injury was assessed according to KDIGO 2017. Results: Sixty-six patients were included in the study. In addition to colistin therapy, 33 cases who received at least three grams of ascorbic acid per day and 33 cases who received only colistin therapy were evaluated retrospectively. Acute kidney injury developed in 12 (36.4%) of those receiving ascorbic acid and 15 (45.5%) in those not receiving ascorbic acid (p= 0.617). Acute kidney injury developed in 9.1 +/- 5.9 days in ascorbic acid patients and 7.1 +/- 4.4 days in non-ascorbic acid patients (p= 0.314). The rate of septic shock development was significantly lower in patients receiving ascorbic acid (30.3% vs 57.6%, p= 0.046). Advanced age (p= 0.005), sepsis (p= 0.046), and underlying cardiac disease (p= 0.01) were found to be statistically significant in terms of the development of nephrotoxicity. Conclusion: Although no statistically significant effect of ascorbic acid using on the development of colistin-related nephrotoxicity was determined in our study, we think that high dose vitamin C may be beneficial in selected patient groups in terms of the fact that AKI is seen less in the group using ascorbic acid, does not have serious side effects and has a positive effect on preventing from septic shock. However further research is needed with more patients

Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study"

WOS: 000366655100045PubMed ID: 26386176BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available. (C) 2015 Elsevier Inc. All rights reserved