Use of colistin in adult patients: A cross-sectional study

Daniele Roberto Giacobbe, Carolina Saffioti, Angela Raffaella Losito, Matteo Rinaldi, Caterina Aurilio, Cesare Bolla, Silvia Boni, Guglielmo Borgia, Novella Carannante, Giovanni Cassola, Giancarlo Ceccarelli, Silvia Corcione, Daniela Dalla Gasperina, Francesco Giuseppe De Rosa, Chiara Dentone, Stefano Di Bella, Nicoletta Di Lauria, Marcello Feasi, Marco Fiore, Sara FossatiErica Franceschini, Andrea Gori, Guido Granata, Sara Grignolo, Paolo Antonio Grossi, Giuliana Guadagnino, Filippo Lagi, Alberto Enrico Maraolo, Valeria Marinò, Maria Mazzitelli, Alessandra Mularoni, Alessandra Oliva, Maria Caterina Pace, Andrea Parisini, Francesca Patti, Nicola Petrosillo, Vincenzo Pota, Francesca Raffaelli, Marianna Rossi, Antonella Santoro, Carlo Tascini, Carlo Torti, Enrico Maria Trecarichi, Mario Venditti, Pierluigi Viale, Alessio Signori, Matteo Bassetti, Valerio Del Bono, Maddalena Giannella, Malgorzata Mikulska, Mario Tumbarello, Claudio Viscoli

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: The aim of this study was to assess colistin use in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). Methods: Colistin prescription patterns were evaluated in 22 Italian centres. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. Results: A total of 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52–73 years) and 134 (61%) were male. 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 MU of colistimethate was administered in 79% of patients receiving i.v. colistin and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy [odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.24–8.53;P = 0.017] and targeted therapy for carbapenem-resistant Enterobacterales infection (OR = 4.76, 95% CI 1.69–13.43; P = 0.003) were associated with use of colistin in combination with other agents, whilst chronic renal failure (OR = 0.39, 95% CI 0.17–0.88; P = 0.024) was associated with use of colistin monotherapy. Conclusion: Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimising its use owing to peculiar pharmacokinetic/pharmacodynamic characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.

Original languageEnglish
Pages (from-to)43-49
Number of pages7
JournalJournal of Global Antimicrobial Resistance
DOIs
Publication statusE-pub ahead of print - Jun 14 2019

Keywords

  • Acinetobacter
  • Antimicrobial resistance
  • Colistimethate
  • Colistin
  • Klebsiella
  • Pseudomonas

ASJC Scopus subject areas

  • Microbiology
  • Immunology and Allergy
  • Immunology
  • Microbiology (medical)

Cite this

Use of colistin in adult patients : A cross-sectional study. / Giacobbe, Daniele Roberto; Saffioti, Carolina; Losito, Angela Raffaella; Rinaldi, Matteo; Aurilio, Caterina; Bolla, Cesare; Boni, Silvia; Borgia, Guglielmo; Carannante, Novella; Cassola, Giovanni; Ceccarelli, Giancarlo; Corcione, Silvia; Dalla Gasperina, Daniela; De Rosa, Francesco Giuseppe; Dentone, Chiara; Di Bella, Stefano; Di Lauria, Nicoletta; Feasi, Marcello; Fiore, Marco; Fossati, Sara; Franceschini, Erica; Gori, Andrea; Granata, Guido; Grignolo, Sara; Grossi, Paolo Antonio; Guadagnino, Giuliana; Lagi, Filippo; Maraolo, Alberto Enrico; Marinò, Valeria; Mazzitelli, Maria; Mularoni, Alessandra; Oliva, Alessandra; Pace, Maria Caterina; Parisini, Andrea; Patti, Francesca; Petrosillo, Nicola; Pota, Vincenzo; Raffaelli, Francesca; Rossi, Marianna; Santoro, Antonella; Tascini, Carlo; Torti, Carlo; Trecarichi, Enrico Maria; Venditti, Mario; Viale, Pierluigi; Signori, Alessio; Bassetti, Matteo; Del Bono, Valerio; Giannella, Maddalena; Mikulska, Malgorzata; Tumbarello, Mario; Viscoli, Claudio.

In: Journal of Global Antimicrobial Resistance, 14.06.2019, p. 43-49.

Research output: Contribution to journalArticle

Giacobbe, DR, Saffioti, C, Losito, AR, Rinaldi, M, Aurilio, C, Bolla, C, Boni, S, Borgia, G, Carannante, N, Cassola, G, Ceccarelli, G, Corcione, S, Dalla Gasperina, D, De Rosa, FG, Dentone, C, Di Bella, S, Di Lauria, N, Feasi, M, Fiore, M, Fossati, S, Franceschini, E, Gori, A, Granata, G, Grignolo, S, Grossi, PA, Guadagnino, G, Lagi, F, Maraolo, AE, Marinò, V, Mazzitelli, M, Mularoni, A, Oliva, A, Pace, MC, Parisini, A, Patti, F, Petrosillo, N, Pota, V, Raffaelli, F, Rossi, M, Santoro, A, Tascini, C, Torti, C, Trecarichi, EM, Venditti, M, Viale, P, Signori, A, Bassetti, M, Del Bono, V, Giannella, M, Mikulska, M, Tumbarello, M & Viscoli, C 2019, 'Use of colistin in adult patients: A cross-sectional study', Journal of Global Antimicrobial Resistance, pp. 43-49. https://doi.org/10.1016/j.jgar.2019.06.009
Giacobbe DR, Saffioti C, Losito AR, Rinaldi M, Aurilio C, Bolla C et al. Use of colistin in adult patients: A cross-sectional study. Journal of Global Antimicrobial Resistance. 2019 Jun 14;43-49. https://doi.org/10.1016/j.jgar.2019.06.009
Giacobbe, Daniele Roberto ; Saffioti, Carolina ; Losito, Angela Raffaella ; Rinaldi, Matteo ; Aurilio, Caterina ; Bolla, Cesare ; Boni, Silvia ; Borgia, Guglielmo ; Carannante, Novella ; Cassola, Giovanni ; Ceccarelli, Giancarlo ; Corcione, Silvia ; Dalla Gasperina, Daniela ; De Rosa, Francesco Giuseppe ; Dentone, Chiara ; Di Bella, Stefano ; Di Lauria, Nicoletta ; Feasi, Marcello ; Fiore, Marco ; Fossati, Sara ; Franceschini, Erica ; Gori, Andrea ; Granata, Guido ; Grignolo, Sara ; Grossi, Paolo Antonio ; Guadagnino, Giuliana ; Lagi, Filippo ; Maraolo, Alberto Enrico ; Marinò, Valeria ; Mazzitelli, Maria ; Mularoni, Alessandra ; Oliva, Alessandra ; Pace, Maria Caterina ; Parisini, Andrea ; Patti, Francesca ; Petrosillo, Nicola ; Pota, Vincenzo ; Raffaelli, Francesca ; Rossi, Marianna ; Santoro, Antonella ; Tascini, Carlo ; Torti, Carlo ; Trecarichi, Enrico Maria ; Venditti, Mario ; Viale, Pierluigi ; Signori, Alessio ; Bassetti, Matteo ; Del Bono, Valerio ; Giannella, Maddalena ; Mikulska, Malgorzata ; Tumbarello, Mario ; Viscoli, Claudio. / Use of colistin in adult patients : A cross-sectional study. In: Journal of Global Antimicrobial Resistance. 2019 ; pp. 43-49.
@article{820e4944710a4b7b928aa4192e536a0b,
title = "Use of colistin in adult patients: A cross-sectional study",
abstract = "Objectives: The aim of this study was to assess colistin use in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). Methods: Colistin prescription patterns were evaluated in 22 Italian centres. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. Results: A total of 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52–73 years) and 134 (61{\%}) were male. 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 MU of colistimethate was administered in 79{\%} of patients receiving i.v. colistin and adequate maintenance doses in 85{\%}. In multivariable analysis, empirical therapy [odds ratio (OR) = 3.25, 95{\%} confidence interval (CI) 1.24–8.53;P = 0.017] and targeted therapy for carbapenem-resistant Enterobacterales infection (OR = 4.76, 95{\%} CI 1.69–13.43; P = 0.003) were associated with use of colistin in combination with other agents, whilst chronic renal failure (OR = 0.39, 95{\%} CI 0.17–0.88; P = 0.024) was associated with use of colistin monotherapy. Conclusion: Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimising its use owing to peculiar pharmacokinetic/pharmacodynamic characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.",
keywords = "Acinetobacter, Antimicrobial resistance, Colistimethate, Colistin, Klebsiella, Pseudomonas",
author = "Giacobbe, {Daniele Roberto} and Carolina Saffioti and Losito, {Angela Raffaella} and Matteo Rinaldi and Caterina Aurilio and Cesare Bolla and Silvia Boni and Guglielmo Borgia and Novella Carannante and Giovanni Cassola and Giancarlo Ceccarelli and Silvia Corcione and {Dalla Gasperina}, Daniela and {De Rosa}, {Francesco Giuseppe} and Chiara Dentone and {Di Bella}, Stefano and {Di Lauria}, Nicoletta and Marcello Feasi and Marco Fiore and Sara Fossati and Erica Franceschini and Andrea Gori and Guido Granata and Sara Grignolo and Grossi, {Paolo Antonio} and Giuliana Guadagnino and Filippo Lagi and Maraolo, {Alberto Enrico} and Valeria Marin{\`o} and Maria Mazzitelli and Alessandra Mularoni and Alessandra Oliva and Pace, {Maria Caterina} and Andrea Parisini and Francesca Patti and Nicola Petrosillo and Vincenzo Pota and Francesca Raffaelli and Marianna Rossi and Antonella Santoro and Carlo Tascini and Carlo Torti and Trecarichi, {Enrico Maria} and Mario Venditti and Pierluigi Viale and Alessio Signori and Matteo Bassetti and {Del Bono}, Valerio and Maddalena Giannella and Malgorzata Mikulska and Mario Tumbarello and Claudio Viscoli",
year = "2019",
month = "6",
day = "14",
doi = "10.1016/j.jgar.2019.06.009",
language = "English",
pages = "43--49",
journal = "Journal of Global Antimicrobial Resistance",
issn = "2213-7165",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Use of colistin in adult patients

T2 - A cross-sectional study

AU - Giacobbe, Daniele Roberto

AU - Saffioti, Carolina

AU - Losito, Angela Raffaella

AU - Rinaldi, Matteo

AU - Aurilio, Caterina

AU - Bolla, Cesare

AU - Boni, Silvia

AU - Borgia, Guglielmo

AU - Carannante, Novella

AU - Cassola, Giovanni

AU - Ceccarelli, Giancarlo

AU - Corcione, Silvia

AU - Dalla Gasperina, Daniela

AU - De Rosa, Francesco Giuseppe

AU - Dentone, Chiara

AU - Di Bella, Stefano

AU - Di Lauria, Nicoletta

AU - Feasi, Marcello

AU - Fiore, Marco

AU - Fossati, Sara

AU - Franceschini, Erica

AU - Gori, Andrea

AU - Granata, Guido

AU - Grignolo, Sara

AU - Grossi, Paolo Antonio

AU - Guadagnino, Giuliana

AU - Lagi, Filippo

AU - Maraolo, Alberto Enrico

AU - Marinò, Valeria

AU - Mazzitelli, Maria

AU - Mularoni, Alessandra

AU - Oliva, Alessandra

AU - Pace, Maria Caterina

AU - Parisini, Andrea

AU - Patti, Francesca

AU - Petrosillo, Nicola

AU - Pota, Vincenzo

AU - Raffaelli, Francesca

AU - Rossi, Marianna

AU - Santoro, Antonella

AU - Tascini, Carlo

AU - Torti, Carlo

AU - Trecarichi, Enrico Maria

AU - Venditti, Mario

AU - Viale, Pierluigi

AU - Signori, Alessio

AU - Bassetti, Matteo

AU - Del Bono, Valerio

AU - Giannella, Maddalena

AU - Mikulska, Malgorzata

AU - Tumbarello, Mario

AU - Viscoli, Claudio

PY - 2019/6/14

Y1 - 2019/6/14

N2 - Objectives: The aim of this study was to assess colistin use in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). Methods: Colistin prescription patterns were evaluated in 22 Italian centres. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. Results: A total of 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52–73 years) and 134 (61%) were male. 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 MU of colistimethate was administered in 79% of patients receiving i.v. colistin and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy [odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.24–8.53;P = 0.017] and targeted therapy for carbapenem-resistant Enterobacterales infection (OR = 4.76, 95% CI 1.69–13.43; P = 0.003) were associated with use of colistin in combination with other agents, whilst chronic renal failure (OR = 0.39, 95% CI 0.17–0.88; P = 0.024) was associated with use of colistin monotherapy. Conclusion: Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimising its use owing to peculiar pharmacokinetic/pharmacodynamic characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.

AB - Objectives: The aim of this study was to assess colistin use in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). Methods: Colistin prescription patterns were evaluated in 22 Italian centres. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. Results: A total of 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52–73 years) and 134 (61%) were male. 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 MU of colistimethate was administered in 79% of patients receiving i.v. colistin and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy [odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.24–8.53;P = 0.017] and targeted therapy for carbapenem-resistant Enterobacterales infection (OR = 4.76, 95% CI 1.69–13.43; P = 0.003) were associated with use of colistin in combination with other agents, whilst chronic renal failure (OR = 0.39, 95% CI 0.17–0.88; P = 0.024) was associated with use of colistin monotherapy. Conclusion: Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimising its use owing to peculiar pharmacokinetic/pharmacodynamic characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.

KW - Acinetobacter

KW - Antimicrobial resistance

KW - Colistimethate

KW - Colistin

KW - Klebsiella

KW - Pseudomonas

UR - http://www.scopus.com/inward/record.url?scp=85076495359&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076495359&partnerID=8YFLogxK

U2 - 10.1016/j.jgar.2019.06.009

DO - 10.1016/j.jgar.2019.06.009

M3 - Article

C2 - 31207379

AN - SCOPUS:85076495359

SP - 43

EP - 49

JO - Journal of Global Antimicrobial Resistance

JF - Journal of Global Antimicrobial Resistance

SN - 2213-7165

ER -