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

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)

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    Giacobbe, D. R., Saffioti, C., Losito, A. R., Rinaldi, M., Aurilio, C., Bolla, C., Boni, S., Borgia, G., Carannante, N., Cassola, G., Ceccarelli, G., Corcione, S., Dalla Gasperina, D., De Rosa, F. G., Dentone, C., Di Bella, S., Di Lauria, N., Feasi, M., Fiore, M., ... Viscoli, C. (2019). Use of colistin in adult patients: A cross-sectional study. Journal of Global Antimicrobial Resistance, 43-49. https://doi.org/10.1016/j.jgar.2019.06.009