Objectives The objective of this study was to assess the use of colistin in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). Methods Colistin prescription patterns were evaluated in 22 Italian centers. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. Results During the study period, 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52-73), and 134 were males (61%). Colistin was mostly administered intravenously (203/221, 92%), and mainly for targeted therapy (168/221, 76%). The most frequent indications for colistin therapy were bloodstream infection and lower respiratory tract infection. Intravenous colistin was administered in combination with at least another anti-MDR-GNB agent in 80% of cases (163/203). A loading dose of 9 million units of colistimethate was administered in 79% of patients, and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy (odds ratio [OR] 3.25, 95% confidence intervals [CI] 1.24-8.53, p = 0.017) and targeted therapy of carbapenem-resistant Enterobacterales infections (OR 4.76, 95% CI 1.69-13.43, p = 0.003) were associated with use of colistin in combinations with other agents, while chronic renal failure (OR 0.39, 95% CI 0.17-0.88, p = 0.024) was associated with use of colistin as monotherapy. Conclusions Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimizing its use due to peculiar PK/PD characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.
Use of colistin in adult patients: a cross-sectional study / D.R. Giacobbe, C. Saffioti, A.R. Losito, M. Rinaldi, C. Aurilio, C. Bolla, S. Boni, G. Borgia, N. Carannante, G. Cassola, G. Ceccarelli, S. Corcione, D. Dalla Gasperina, F.G. De Rosa, C. Dentone, S. Di Bella, N. Di Lauria, M. Feasi, M. Fiore, S. Fossati, E. Franceschini, A. Gori, G. Granata, S. Grignolo, P.A. Grossi, G. Guadagnino, F. Lagi, A.E. Maraolo, V. Marinò, M. Mazzitelli, A. Mularoni, A. Oliva, M.C. Pace, A. Parisini, F. Patti, N. Petrosillo, V. Pota, F. Raffaelli, M. Rossi, A. Santoro, C. Tascini, C. Torti, E.M. Trecarichi, M. Venditti, P. Viale, A. Signori, M. Bassetti, V. Del Bono, M. Giannella, M. Mikulska, M. Tumbarello, C. Viscoli. - In: JOURNAL OF GLOBAL ANTIMICROBIAL RESISTANCE. - ISSN 2213-7165. - (2019 Jun 15). [Epub ahead of print] [10.1016/j.jgar.2019.06.009]
Use of colistin in adult patients: a cross-sectional study
D.R. Giacobbe;S. Di Bella;M. Fiore;A. Gori;M. Rossi;
2019
Abstract
Objectives The objective of this study was to assess the use of colistin in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). Methods Colistin prescription patterns were evaluated in 22 Italian centers. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. Results During the study period, 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52-73), and 134 were males (61%). Colistin was mostly administered intravenously (203/221, 92%), and mainly for targeted therapy (168/221, 76%). The most frequent indications for colistin therapy were bloodstream infection and lower respiratory tract infection. Intravenous colistin was administered in combination with at least another anti-MDR-GNB agent in 80% of cases (163/203). A loading dose of 9 million units of colistimethate was administered in 79% of patients, and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy (odds ratio [OR] 3.25, 95% confidence intervals [CI] 1.24-8.53, p = 0.017) and targeted therapy of carbapenem-resistant Enterobacterales infections (OR 4.76, 95% CI 1.69-13.43, p = 0.003) were associated with use of colistin in combinations with other agents, while chronic renal failure (OR 0.39, 95% CI 0.17-0.88, p = 0.024) was associated with use of colistin as monotherapy. Conclusions Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimizing its use due to peculiar PK/PD characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.
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