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

SITA GIOVANI (Young Investigators Group of the Società Italiana Terapia Antinfettiva) and the COLI-CROSS Study Group, 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. FioreS. 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, M. Bassetti, V. Del Bono, M. Mikulska, M. Tumbarello, C. Viscoli

Research output: Contribution to journalArticlepeer-review

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
Volume20
DOIs
Publication statusPublished - 2020

Keywords

  • Acinetobacter
  • Antimicrobial resistance
  • Colistimethate
  • Colistin
  • Klebsiella
  • Pseudomonas
  • amikacin
  • avibactam plus ceftazidime
  • cefepime
  • ceftazidime
  • ceftolozane plus tazobactam
  • colistimethate
  • colistin
  • cotrimoxazole
  • ertapenem
  • fosfomycin
  • gentamicin
  • imipenem
  • levofloxacin
  • meropenem
  • piperacillin plus tazobactam
  • rifampicin
  • sultamicillin
  • tigecycline
  • Acinetobacter infection
  • adult
  • aged
  • antibiotic resistance
  • Article
  • bloodstream infection
  • carbapenem resistance
  • carbapenem resistant Acinetobacter baumannii
  • carbapenem resistant Pseudomonas aeruginosa
  • carbapenem-resistant Enterobacteriaceae
  • chronic kidney failure
  • combination drug therapy
  • cross-sectional study
  • drug indication
  • drug use
  • Enterobacteriaceae infection
  • female
  • Gram negative bacterium
  • human
  • loading drug dose
  • lower respiratory tract infection
  • maintenance drug dose
  • major clinical study
  • male
  • molecularly targeted therapy
  • monotherapy
  • multidrug resistance
  • prescription
  • priority journal
  • Pseudomonas infection

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